Provider Demographics
NPI:1346290053
Name:TEAL, CYDNEY (MD)
Entity Type:Individual
Prefix:
First Name:CYDNEY
Middle Name:
Last Name:TEAL
Suffix:
Gender:F
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 7356
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-7356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-620-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0013123207Q00000X
MDD0056327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD122400000Medicaid
P00826628OtherMEDICARE RAILROAD
P00826628OtherMEDICARE RAILROAD
MD122400000Medicaid