Provider Demographics
NPI:1831191097
Name:LOUDERBACK-SMITH, TEAETTE L (MD)
Entity type:Individual
Prefix:DR
First Name:TEAETTE
Middle Name:L
Last Name:LOUDERBACK-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-0667
Mailing Address - Country:US
Mailing Address - Phone:410-939-8789
Mailing Address - Fax:410-939-6335
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:STE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4305
Practice Address - Country:US
Practice Address - Phone:410-638-5101
Practice Address - Fax:410-638-6854
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405553500Medicaid
MDE4860013OtherBLUE CHOICE/FEP
MD64288501OtherCAREFIRST BC/BS
MD64288501OtherCAREFIRST BC/BS
MD405553500Medicaid