MEDICARE: CHARLES TEITELBAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	137677	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033112487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES TEITELBAUM MD

Provider Business Mailing Address
First Line	:	5792 WIDEWATERS PKWY STE 101
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1847
Country	:	US
Telephone Number	:	315-422-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	5792 WIDEWATERS PKWY STE 101
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1847
Country	:	US
Telephone Number	:	315-422-4412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/27/2019

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