=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275849481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY ALAN TEPLITZ, M.D.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 08/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5530 WISCONSIN AVE 852
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-656-1822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5610 WISCONSIN AVE 609
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-656-1822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TERRY ALAN TEPLITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-656-1822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | D0019308
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------