Provider Demographics
NPI:1912029034
Name:DAVID TEITELBAUM MD PA
Entity Type:Organization
Organization Name:DAVID TEITELBAUM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-365-2929
Mailing Address - Street 1:1000 EXECUTIVE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8140
Mailing Address - Country:US
Mailing Address - Phone:407-365-2929
Mailing Address - Fax:407-365-8518
Practice Address - Street 1:1000 EXECUTIVE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8140
Practice Address - Country:US
Practice Address - Phone:407-365-2929
Practice Address - Fax:407-365-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty