MEDICARE: ROBERT WALTER TEDDER MSW

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	104100000X	Social Worker	SW006872L	PA

General Provider Information

NPI Number	:	1851338404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WALTER TEDDER MSW

Provider Business Mailing Address
First Line	:	2117 COLLINGWOOD ST
Second Line	:
City	:	SWISSVALE
State	:	PA
Zip	:	15218-2525
Country	:	US
Telephone Number	:	412-271-5191
Fax Number	:	412-271-5082

Provider Business Practice Location Address
First Line	:	2106 MONONGAHELA AVE
Second Line	:
City	:	SWISSVALE
State	:	PA
Zip	:	15218-2512
Country	:	US
Telephone Number	:	412-271-5191
Fax Number	:	412-271-5082

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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