Provider Demographics
NPI:1669433900
Name:TEGELER, DEBRA RENEE (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEE
Last Name:TEGELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-4820
Mailing Address - Fax:336-718-1050
Practice Address - Street 1:250 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1508
Practice Address - Country:US
Practice Address - Phone:336-718-1000
Practice Address - Fax:336-718-1050
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982332Medicaid
NC8982332Medicaid
NC2146980Medicare ID - Type Unspecified
NC2146980CMedicare PIN