MEDICARE: RICK DAVID TEETZ 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	207Q00000X	Family Medicine Physician	202502	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00226004	OTHER	NY	RR MEDICARE

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	:	1396733408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICK DAVID TEETZ MD

Provider Business Mailing Address
First Line	:	PO BOX 304
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-0304
Country	:	US
Telephone Number	:	518-587-3600
Fax Number	:	518-581-8266

Provider Business Practice Location Address
First Line	:	131 LAWRENCE ST
Second Line	:	WESLEY HEALTH CARE CENTER INC.
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1346
Country	:	US
Telephone Number	:	518-587-3600
Fax Number	:	518-581-8266

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/05/2012

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