MEDICARE: DR. TIMOTHY A TELLER 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	208000000X	Pediatrics Physician	35063670	OH

General Provider Information

NPI Number	:	1417954744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY A TELLER MD

Provider Business Mailing Address
First Line	:	3855 TRUEMAN COURT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-777-1800
Fax Number	:	614-777-1831

Provider Business Practice Location Address
First Line	:	3855 TRUEMAN COURT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-777-1800
Fax Number	:	614-777-1831

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	05/07/2021

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Directions to “ DR. TIMOTHY A TELLER MD” Practice Location

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