Provider Demographics
NPI:1962430934
Name:OLDSON, TERESSA MAE (MD)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:MAE
Last Name:OLDSON
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 1:2000 CENTER POINT RD STE 2360
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5826
Mailing Address - Country:US
Mailing Address - Phone:803-233-5500
Mailing Address - Fax:
Practice Address - Street 1:2000 CENTER POINT RD STE 2360
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5826
Practice Address - Country:US
Practice Address - Phone:803-233-5500
Practice Address - Fax:803-258-6395
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17442207Q00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC174420Medicaid
SC174420Medicaid
SCAA5657Medicare PIN