Healthcare Provider Details

I. General information

NPI: 1073554713
Provider Name (Legal Business Name): TERESA MARIA CAMDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA SIBENI STADLER M.D., FACSM

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 W BROAD ST 101
RICHMOND VA
23230-3009
US

IV. Provider business mailing address

5252 LYNGATE CT 203
BURKE VA
22015-1672
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-3025
  • Fax: 804-288-3029
Mailing address:
  • Phone: 703-239-2300
  • Fax: 703-239-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0101238212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: