MEDICARE: TEAGAN F O'TOOLE 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
1	363A00000X	Physician Assistant	PA1294	ME

General Provider Information

NPI Number	:	1457639247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAGAN F O'TOOLE PA-C

Provider Business Mailing Address
First Line	:	245 JEFFERSON ST APT B
Second Line	:
City	:	WALDOBORO
State	:	ME
Zip	:	04572-6011
Country	:	US
Telephone Number	:	207-949-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 WHITE ST
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2978
Country	:	US
Telephone Number	:	207-301-6022
Fax Number	:

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

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	03/01/2023

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