Healthcare Provider Details

I. General information

NPI: 1669498028
Provider Name (Legal Business Name): TODD BRIAN TESCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 414
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 414
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-4600
  • Fax: 703-289-4601
Mailing address:
  • Phone: 703-289-4600
  • Fax: 703-289-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101057553
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: