Provider Demographics
NPI:1649279498
Name:RIDDIFORD, TERRI LEA (MD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LEA
Last Name:RIDDIFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13280 EVENING CREEK DR S STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4664
Mailing Address - Country:US
Mailing Address - Phone:937-396-2880
Mailing Address - Fax:937-395-2205
Practice Address - Street 1:13280 EVENING CREEK DR S STE 225
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4664
Practice Address - Country:US
Practice Address - Phone:937-396-2880
Practice Address - Fax:937-395-2205
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4208215OtherAETNA
000000560895OtherBCBS OHIO
OH0928401Medicaid
OHH420500Medicare PIN
F62902Medicare UPIN
OHPR4233321Medicare PIN