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General NPI Number Information
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NPI Number | 1952789265
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Entity Type | Individual
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Provider Name | BRIANNE TEABOLDT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 133 PLEASANT ST UNIT 2
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City | BERLIN
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State | NH
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Zip | 03570
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Country | US
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Telephone | 317-730-4961
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Fax |
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Provider Business Mailing Address
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Address Line | 28 GRANDVIEW DR UNIT 2
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City | BERLIN
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State | NH
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Zip | 03570-1536
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Country | US
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Telephone | 317-730-4961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19158
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License Number State | NH
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