MEDICARE: DR. MARC J TEITELBAUM M.D.

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	D0056640	MD

General Provider Information

NPI Number	:	1841593548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC J TEITELBAUM M.D.

Provider Business Mailing Address
First Line	:	5705 INDUSTRY LN
Second Line	:	ROOM 251
City	:	FREDERICK
State	:	MD
Zip	:	21704-5163
Country	:	US
Telephone Number	:	301-228-4707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5705 INDUSTRY LN
Second Line	:	ROOM 251
City	:	FREDERICK
State	:	MD
Zip	:	21704-5163
Country	:	US
Telephone Number	:	301-228-4707
Fax Number	:

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

Provider Enumeration Date	:	12/19/2010
Last Update Date	:	02/24/2012

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