Healthcare Provider Details

I. General information

NPI: 1710236112
Provider Name (Legal Business Name): LAUREN TETER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 IMPERIAL DR STE 201
HAGERSTOWN MD
21740-6673
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 240-707-3757
  • Fax: 301-791-5234
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: