MEDICARE: JOHN TETERIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35060578	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4090862	OTHER	OH	MEDICARE PTAN
3	TE0722936	OTHER	OH	MEDICARE PTAN MOCA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669414637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TETERIS MD

Provider Business Mailing Address
First Line	:	3600 OLENTANGY RIVER RD
Second Line	:	SUITE 490
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3437
Country	:	US
Telephone Number	:	614-459-1000
Fax Number	:	614-459-1382

Provider Business Practice Location Address
First Line	:	3600 OLENTANGY RIVER RD
Second Line	:	SUITE 490
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3437
Country	:	US
Telephone Number	:	614-898-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/14/2012

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Directions to “ JOHN TETERIS MD” Practice Location

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