1073554713 NPI number — DR. TERESA MARIA CAMDEN M.D.

Table of content: DR. TERESA MARIA CAMDEN M.D. (NPI 1073554713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073554713 NPI number — DR. TERESA MARIA CAMDEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMDEN
Provider First Name:
TERESA
Provider Middle Name:
MARIA
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:
STADLER
Provider Other First Name:
TERESA
Provider Other Middle Name:
SIBENI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., FACSM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073554713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5252 LYNGATE CT
Provider Second Line Business Mailing Address:
203
Provider Business Mailing Address City Name:
BURKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22015-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-239-2300
Provider Business Mailing Address Fax Number:
703-239-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5211 W BROAD ST
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-288-3025
Provider Business Practice Location Address Fax Number:
804-288-3029
Provider Enumeration Date:
06/10/2006

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: 207QS0010X , with the licence number:  0101238212 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 540885859 . This is a "C&O EMPLOYEE'S HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00281047 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10003094 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 185138 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "CORVEL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7575263 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0472640005 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "COMPMANAGEMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 540885859 . This is a "FOCUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010223849 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61270 . This is a "SH CARENET" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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