Healthcare Provider Details

I. General information

NPI: 1316367709
Provider Name (Legal Business Name): TERESA L MARTELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 GATEWAY BLVD
NEWBURGH IN
47630-8954
US

IV. Provider business mailing address

PO BOX 1510
EVANSVILLE IN
47706-1510
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-5300
  • Fax: 812-858-4660
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01079149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: