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General NPI Number Information
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NPI Number | 1689856395
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Entity Type | Organization
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Legal Business Name | MICHAEL TEDFORD MD LLC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 254 ROUTE 17K STE 204
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City | NEWBURGH
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State | NY
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Zip | 12550
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Country | US
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Telephone | 845-561-4466
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Fax | 845-561-7190
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Provider Business Mailing Address
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Address Line | 254 ROUTE 17K STE 204
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City | NEWBURGH
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State | NY
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Zip | 12550-8300
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Country | US
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Telephone | 845-561-4466
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Fax | 845-561-7190
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL GEORGE TEDFORD
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Credential | MD
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Telephone | 845-561-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 203269
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License Number State | NY
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