Provider Demographics
NPI:1841279601
Name:TEODORESCU, RADU H (MD)
Entity type:Individual
Prefix:
First Name:RADU
Middle Name:H
Last Name:TEODORESCU
Suffix:
Gender:M
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10202 SE 32ND AVE
Practice Address - Street 2:STE 701
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-3610
Practice Address - Country:US
Practice Address - Phone:503-513-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030080202084P0800X
KS04-329292084P0800X
ORMD1794332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500715955Medicaid
KS200540710AMedicaid
MO209023803Medicaid
KS106983OtherMEDICARE PTAN
ORP01765514OtherRR MEDICARE (PH&S)-PMG
AR1050505001Medicaid
P00056349OtherTRAVELERS MEDICARE
ORP01765514OtherRR MEDICARE (PH&S)-PMG
MO209023803Medicaid