Healthcare Provider Details

I. General information

NPI: 1942207725
Provider Name (Legal Business Name): TERRENCE FREDERIC ODER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 MAIN ST
HARTFORD CT
06120-1121
US

IV. Provider business mailing address

3580 MAIN ST
HARTFORD CT
06120-1121
US

V. Phone/Fax

Practice location:
  • Phone: 860-241-0700
  • Fax: 860-525-7881
Mailing address:
  • Phone: 860-241-0700
  • Fax: 860-525-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number046133
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: