Provider Demographics
NPI:1811251887
Name:TEITELBAUM, MIRIAM (DO)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:TEITELBAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5889 FORBES AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-4601
Mailing Address - Country:US
Mailing Address - Phone:412-618-3010
Mailing Address - Fax:412-618-3011
Practice Address - Street 1:5889 FORBES AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-4601
Practice Address - Country:US
Practice Address - Phone:412-618-3010
Practice Address - Fax:412-618-3011
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103043588Medicaid
PA13596448OtherCAQH
PA429956Medicare PIN