Provider Demographics
NPI:1144377987
Name:RAJALA, TERESA DEWLETT (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DEWLETT
Last Name:RAJALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1314 W MCDERMOTT DR
Mailing Address - Street 2:SUITE 106, PMB 808
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3021
Mailing Address - Country:US
Mailing Address - Phone:469-252-0022
Mailing Address - Fax:214-383-9587
Practice Address - Street 1:1314 W MCDERMOTT DR
Practice Address - Street 2:SUITE 106, PMB 808
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3021
Practice Address - Country:US
Practice Address - Phone:469-252-0022
Practice Address - Fax:214-383-9587
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0261Medicare ID - Type Unspecified
D87476Medicare UPIN