Provider Demographics
NPI:1356790927
Name:MATTHEWS, TEDDRIC
Entity type:Individual
Prefix:
First Name:TEDDRIC
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 TOURO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4072
Mailing Address - Country:US
Mailing Address - Phone:504-948-6880
Mailing Address - Fax:504-278-4007
Practice Address - Street 1:3308 TULANE AVE STE 407
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7158
Practice Address - Country:US
Practice Address - Phone:504-821-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator