Provider Demographics
NPI:1184611196
Name:TEGELER, JAMES ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:TEGELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 94
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8180
Practice Address - Fax:717-741-8196
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023982E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA557109OtherHIGHMARK BLUE SHIELD
PA001153381Medicaid
PA1521071OtherGATEWAY-WMG
PA20091166OtherAMERIHEALTH MERCY-WMG
PA276157OtherUNISON HEALTH PLAN (WMG)
PA557109OtherHIGHMARK BLUE SHIELD
PA276157OtherUNISON HEALTH PLAN (WMG)
E13056Medicare UPIN