Provider Demographics
NPI:1336710748
Name:TERESA LICCARDI, M.D., PLLC
Entity Type:Organization
Organization Name:TERESA LICCARDI, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/ ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LICCARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-461-8050
Mailing Address - Street 1:1153 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5425
Mailing Address - Country:US
Mailing Address - Phone:980-461-8050
Mailing Address - Fax:
Practice Address - Street 1:1153 10TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5425
Practice Address - Country:US
Practice Address - Phone:980-461-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty