Healthcare Provider Details

I. General information

NPI: 1336127307
Provider Name (Legal Business Name): FRED TEICHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ARCH ST SUITE B
SUNBURY PA
17801-2299
US

IV. Provider business mailing address

PO BOX 65
SUNBURY PA
17801-0065
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-0608
  • Fax: 570-286-1102
Mailing address:
  • Phone: 570-286-0608
  • Fax: 570-286-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD026556E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD026556E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: