Healthcare Provider Details

I. General information

NPI: 1619493350
Provider Name (Legal Business Name): CATHERINE TEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 LUNENBURG AVE
VICTORIA VA
23974-9595
US

IV. Provider business mailing address

1603 LUNENBURG AVE
VICTORIA VA
23974-9595
US

V. Phone/Fax

Practice location:
  • Phone: 434-321-2235
  • Fax:
Mailing address:
  • Phone: 434-321-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: