Provider Demographics
NPI:1265768709
Name:EDWARDS, TERESA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:UNIT 2502
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0560342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology