Provider Demographics
NPI:1295836062
Name:TEPPIG, ANNA K (PA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:K
Last Name:TEPPIG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:K
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:875 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2203
Mailing Address - Country:US
Mailing Address - Phone:717-763-7400
Mailing Address - Fax:717-909-9567
Practice Address - Street 1:875 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-763-7400
Practice Address - Fax:717-909-9567
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004576363A00000X
VA0110004629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA461763340AMedicaid
GA461763340AMedicaid