Provider Demographics
NPI:1285725622
Name:JERALDO, TERESA LORENA (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LORENA
Last Name:JERALDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4934
Mailing Address - Country:US
Mailing Address - Phone:401-312-0444
Mailing Address - Fax:401-312-0446
Practice Address - Street 1:967 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4934
Practice Address - Country:US
Practice Address - Phone:401-312-0444
Practice Address - Fax:401-312-0446
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 08939208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINEIGHBORHOOD HEALTHOther1688
RITUFTSOther406145
RI23120-6OtherBLUE CROSS & BLUE SHIELD
RIMS47209Medicaid
RIUNITED HEALTH CAREOther12-02780
RIBLUE CHIPOther400266
G59329Medicare UPIN