1427292812 NPI number — DR. ANDREA SPAULDING TEAGUE M.D.

Table of content: DR. ANDREA SPAULDING TEAGUE M.D. (NPI 1427292812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427292812 NPI number — DR. ANDREA SPAULDING TEAGUE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEAGUE
Provider First Name:
ANDREA
Provider Middle Name:
SPAULDING
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPAULDING
Provider Other First Name:
ANDREA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427292812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490A W ZIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-6996
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-913-8900
Provider Business Mailing Address Fax Number:
505-913-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 NEW SCOTLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-331-1166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MD2016-0096 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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