Provider Demographics
NPI:1437226735
Name:TEAGUE-SMITH, ROCHELLE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:RENEE
Last Name:TEAGUE-SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:RENEE
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1155 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3904
Mailing Address - Country:US
Mailing Address - Phone:267-205-2494
Mailing Address - Fax:
Practice Address - Street 1:1155 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3904
Practice Address - Country:US
Practice Address - Phone:267-205-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002141L363AM0700X
NY23011510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23011510OtherNEW YORK LICENSE