Provider Demographics
NPI:1952789265
Name:TEABOLDT, BRIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:
Last Name:TEABOLDT
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 1:28 GRANDVIEW DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-1536
Mailing Address - Country:US
Mailing Address - Phone:317-730-4961
Mailing Address - Fax:
Practice Address - Street 1:133 PLEASANT ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570
Practice Address - Country:US
Practice Address - Phone:317-730-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine