Provider Demographics
NPI:1508314659
Name:TEASDALE, DANIEL GRAHAM (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GRAHAM
Last Name:TEASDALE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 405 BOX 1969
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0020
Mailing Address - Country:US
Mailing Address - Phone:808-620-5085
Mailing Address - Fax:
Practice Address - Street 1:DR. HITZELBERGER-STRASSE
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:RHINELAND FALLS
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:808-620-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant