Healthcare Provider Details

I. General information

NPI: 1689068504
Provider Name (Legal Business Name): ANDREI TEODOSESCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 POINT LOOKOUT RD
LEONARDTOWN MD
20650-2015
US

IV. Provider business mailing address

3114 WISCONSIN AVE NW APT 702
WASHINGTON DC
20016-5082
US

V. Phone/Fax

Practice location:
  • Phone: 301-221-3563
  • Fax:
Mailing address:
  • Phone: 301-221-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD0091195
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD91195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: