Provider Demographics
NPI:1437267325
Name:CARANGAL, TEODORO R CARANGAL REYES (MD)
Entity Type:Individual
Prefix:DR
First Name:TEODORO R CARANGAL
Middle Name:REYES
Last Name:CARANGAL
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 1:2404 GIRDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2635
Mailing Address - Country:US
Mailing Address - Phone:410-252-2863
Mailing Address - Fax:410-252-2863
Practice Address - Street 1:2404 GIRDWOOD RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2635
Practice Address - Country:US
Practice Address - Phone:410-252-2863
Practice Address - Fax:410-252-2863
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014927207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05627100Medicaid
MD2108TRMedicare ID - Type Unspecified