Healthcare Provider Details

I. General information

NPI: 1841262722
Provider Name (Legal Business Name): TERRANCE TADDEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NASA PKWY MAIL CODE SD2
HOUSTON TX
77058-3607
US

IV. Provider business mailing address

2101 NASA PKWY MAIL CODE SD2
HOUSTON TX
77058-3607
US

V. Phone/Fax

Practice location:
  • Phone: 281-483-7041
  • Fax: 281-244-7947
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberK0212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: