Provider Demographics
NPI:1841593548
Name:TEITELBAUM, MARC J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:TEITELBAUM
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 1:5705 INDUSTRY LN
Mailing Address - Street 2:ROOM 251
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5163
Mailing Address - Country:US
Mailing Address - Phone:301-228-4707
Mailing Address - Fax:
Practice Address - Street 1:5705 INDUSTRY LN
Practice Address - Street 2:ROOM 251
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5163
Practice Address - Country:US
Practice Address - Phone:301-228-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-19
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056640207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology