Provider Demographics
NPI:1841335874
Name:OLDHAM, TERESA ANN (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:OLDHAM
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 1:2425 MILO B. SAMPSON LANE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1398
Mailing Address - Country:US
Mailing Address - Phone:812-349-5074
Mailing Address - Fax:812-349-5046
Practice Address - Street 1:2425 MILO B. SAMPSON LANE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1398
Practice Address - Country:US
Practice Address - Phone:812-349-5074
Practice Address - Fax:812-349-5130
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062429A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200894620Medicaid
IN000000561415OtherANTHEM BCBS
IN200894620Medicaid