Provider Demographics
NPI:1790745016
Name:WILLOCHELL, TERI A (MD)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:A
Last Name:WILLOCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERI
Other - Middle Name:WILLOCHELL
Other - Last Name:ECKELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:816 MIDDLE ST
Mailing Address - Street 2:ADULT INTERNAL MEDICINE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4915
Mailing Address - Country:US
Mailing Address - Phone:412-321-4001
Mailing Address - Fax:412-321-4063
Practice Address - Street 1:816 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4915
Practice Address - Country:US
Practice Address - Phone:412-321-4001
Practice Address - Fax:412-321-4063
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062233L173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001646400Medicaid
PA001646400Medicaid
PA954630EVQMedicare ID - Type UnspecifiedINDIVIDUAL
PA001646400Medicaid