Healthcare Provider Details

I. General information

NPI: 1841335874
Provider Name (Legal Business Name): TERESA ANN OLDHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MILO B. SAMPSON LANE
BLOOMINGTON IN
47408-1398
US

IV. Provider business mailing address

2425 MILO B. SAMPSON LANE
BLOOMINGTON IN
47408-1398
US

V. Phone/Fax

Practice location:
  • Phone: 812-349-5074
  • Fax: 812-349-5130
Mailing address:
  • Phone: 812-349-5074
  • Fax: 812-349-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01062429A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: