Provider Demographics
NPI:1528110244
Name:TRETTER, THERESA MARIE (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:TRETTER
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 1:566 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2799
Mailing Address - Country:US
Mailing Address - Phone:401-738-4800
Mailing Address - Fax:401-738-8153
Practice Address - Street 1:566 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-4800
Practice Address - Fax:401-738-8153
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197268207W00000X
RIMD16398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0498535OtherGHI
1926266OtherUNITED
11006585OtherACS MULTIPLAN
NYP1497267OtherOXFORD
NY01860122Medicaid
7860722OtherCIGNA
197268A40OtherHEALTHFIRST
32259POtherHIP
NY421B01OtherBCBS
4C3021OtherHEALTHNET
0100703OtherAMERICHOICE
396067OtherCONNECTICARE
5490713OtherAETNA
TT7268OtherATLANTIS
11006585OtherACS MULTIPLAN
NY421B01OtherBCBS