Provider Demographics
NPI:1669528022
Name:TECKLENBERG, PAUL LEO (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEO
Last Name:TECKLENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:128 VOLLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28040-4710
Mailing Address - Country:US
Mailing Address - Phone:828-248-1589
Mailing Address - Fax:828-248-1589
Practice Address - Street 1:128 VOLLEY ROAD
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:NC
Practice Address - Zip Code:28040-4710
Practice Address - Country:US
Practice Address - Phone:828-248-1589
Practice Address - Fax:828-248-1589
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B67149Medicare UPIN