Provider Demographics
NPI:1881634889
Name:TELLERS, JOHN G (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:TELLERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-242-9260
Mailing Address - Fax:304-242-9484
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 500
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6392
Practice Address - Country:US
Practice Address - Phone:304-242-9260
Practice Address - Fax:304-242-9484
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0091065000Medicaid
OH0508838Medicaid
OH0428953Medicare ID - Type UnspecifiedMEDICARE PROVIDER
OH0508838Medicaid
WVA35900Medicare UPIN