Provider Demographics
NPI:1497951909
Name:TEGLASSY, ZOLTAN (MD)
Entity Type:Individual
Prefix:
First Name:ZOLTAN
Middle Name:
Last Name:TEGLASSY
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 1:1341 RANIER LOOP NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2023
Mailing Address - Country:US
Mailing Address - Phone:315-366-4811
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER STREET NE
Practice Address - Street 2:OREGON STATE HOSPITAL- MEDICAL CLINIC
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-945-7125
Practice Address - Fax:541-465-2675
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR023015Medicaid
OR381810Medicare Oscar/Certification
ORR0000WCHJMMedicare PIN