Provider Demographics
NPI:1295791952
Name:TEALDI, CHRISTINE MARIA (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIA
Last Name:TEALDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARIA
Other - Last Name:GIVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:401 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5741
Mailing Address - Country:US
Mailing Address - Phone:970-240-8199
Mailing Address - Fax:970-249-9185
Practice Address - Street 1:401 S PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5741
Practice Address - Country:US
Practice Address - Phone:970-240-8199
Practice Address - Fax:970-249-9185
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1334363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COTET46814OtherBLUE CROSS/BLUE SHIELD
CO65724062Medicaid
CO841608597006OtherROCKY MOUNTAIN HEALTH PLA
CO841608597006OtherROCKY MOUNTAIN HEALTH PLA
COTET46814OtherBLUE CROSS/BLUE SHIELD