MEDICARE: DR. THERESA DURCHHALTER D.O.

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	207N00000X	Dermatology Physician	290730	NY

General Provider Information

NPI Number	:	1427419241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA DURCHHALTER D.O.

Provider Business Mailing Address
First Line	:	998 THIRD AVE
Second Line	:
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-1846
Country	:	US
Telephone Number	:	516-640-1336
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3972
Country	:	US
Telephone Number	:	718-491-5800
Fax Number	:

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

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	06/28/2021

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