Provider Demographics
NPI:1396733408
Name:TEETZ, RICK DAVID (MD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:DAVID
Last Name:TEETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-587-3600
Mailing Address - Fax:518-581-8266
Practice Address - Street 1:131 LAWRENCE ST
Practice Address - Street 2:WESLEY HEALTH CARE CENTER INC.
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1346
Practice Address - Country:US
Practice Address - Phone:518-587-3600
Practice Address - Fax:518-581-8266
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862115Medicaid
NYP00226004OtherRR MEDICARE
NYP00226004OtherRR MEDICARE
G76061Medicare UPIN