1346337581 NPI number — TABOR-ADAMS INTERNAL MEDICINE PC

Table of content: MR. MICHAEL H. TEAGUE MSW, LADAC, LMSW, (NPI 1700097672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346337581 NPI number — TABOR-ADAMS INTERNAL MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TABOR-ADAMS INTERNAL MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346337581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 LORIMER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-8111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-288-8200
Provider Business Mailing Address Fax Number:
215-288-5091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6420 RISING SUN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-725-7550
Provider Business Practice Location Address Fax Number:
215-725-1018
Provider Enumeration Date:
10/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THAIN
Authorized Official First Name:
OUNG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-288-8200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD060716L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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