Provider Demographics
NPI:1336127307
Name:TEICHMAN, FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:TEICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-0065
Mailing Address - Country:US
Mailing Address - Phone:570-286-0608
Mailing Address - Fax:570-286-1102
Practice Address - Street 1:301 ARCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2299
Practice Address - Country:US
Practice Address - Phone:570-286-0608
Practice Address - Fax:570-286-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026556E174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009985060001Medicaid
PAB34010Medicare UPIN
PA0009985060001Medicaid