Provider Demographics
NPI:1558366237
Name:TEEHAN, GEOFFREY STEPHAN (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:STEPHAN
Last Name:TEEHAN
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 1:100 E LANCASTER AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3453
Mailing Address - Country:US
Mailing Address - Phone:610-649-1175
Mailing Address - Fax:610-896-8753
Practice Address - Street 1:100 E LANCASTER AVE STE 130
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3453
Practice Address - Country:US
Practice Address - Phone:610-649-1175
Practice Address - Fax:610-896-8753
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426100207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14535Medicare UPIN