Healthcare Provider Details

I. General information

NPI: 1467775809
Provider Name (Legal Business Name): GEORGE P TEITELBAUM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S. BUENA VISTA ST.
BURBANK CA
91505-4809
US

IV. Provider business mailing address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4835
  • Fax: 818-847-4842
Mailing address:
  • Phone: 818-847-4835
  • Fax: 818-847-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG45097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG45097
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG45097
License Number StateCA

VIII. Authorized Official

Name: GEORGE P TEITELBAUM
Title or Position: OWNER
Credential: M.D.
Phone: 818-847-4835