Provider Demographics
NPI:1629067178
Name:TEEBAGY, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:TEEBAGY
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 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE C-350
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2539
Mailing Address - Country:US
Mailing Address - Phone:954-731-9676
Mailing Address - Fax:954-731-9747
Practice Address - Street 1:1800 N FEDERAL HWY
Practice Address - Street 2:#110
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1095
Practice Address - Country:US
Practice Address - Phone:954-941-5731
Practice Address - Fax:954-941-2706
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049580800Medicaid
D51681Medicare UPIN