Provider Demographics
NPI:1295965580
Name:TETER BABIAK, MARY JUDE (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JUDE
Last Name:TETER BABIAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:TETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:930 HENRIETTA AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006
Mailing Address - Country:US
Mailing Address - Phone:215-663-5775
Mailing Address - Fax:215-663-5673
Practice Address - Street 1:930 HENRIETTA AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-663-5775
Practice Address - Fax:215-663-5673
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003324L208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases