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NPI Code Detail

MEDICARE: DR. PHILIP TEITELBAUM M.D.

MEDICARE: DR. PHILIP TEITELBAUM M.D.
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
12085P0229XPediatric Radiology Physician243722MA
22085R0202XDiagnostic Radiology PhysicianME110484FL

General Provider Information

NPI Number : 1104012715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP TEITELBAUM M.D.
Provider Business Mailing Address
First Line : PO BOX 919336
Second Line : CHILDREN'S HOSPITAL BOSTON
City : ORLANDO
State : FL
Zip : 32891-9336
Country : US
Telephone Number : 786-596-1960
Fax Number :
Provider Business Practice Location Address
First Line : 8900 N. KENDALL DRIVE
Second Line : CHILDREN'S HOSPITAL BOSTON
City : MIAMI
State : FL
Zip : 33176-2118
Country : US
Telephone Number : 786-596-1960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 07/20/2011

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