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NPI Code Detail

MEDICARE: MS. TERESA A. KOEBEL PA-C

MEDICARE: MS. TERESA A. KOEBEL PA-C
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
1363A00000XPhysician AssistantC0002041MD
2363A00000XPhysician AssistantC002041MD

General Provider Information

NPI Number : 1255400404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERESA A. KOEBEL PA-C
Provider Business Mailing Address
First Line : 2000 MEDICAL PKWY
Second Line : STE 101
City : ANNAPOLIS
State : MD
Zip : 21401-3743
Country : US
Telephone Number : 410-295-8900
Fax Number : 443-481-6515
Provider Business Practice Location Address
First Line : 2000 MEDICAL PKWY
Second Line : STE 101
City : ANNAPOLIS
State : MD
Zip : 21401-3743
Country : US
Telephone Number : 410-295-8900
Fax Number : 443-481-6515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 04/29/2016

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