Provider Demographics
NPI:1174548374
Name:TEAL, JAMES S (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:TEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2024 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3027
Mailing Address - Country:US
Mailing Address - Phone:202-865-3415
Mailing Address - Fax:202-865-6876
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1571
Practice Address - Fax:202-865-3285
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD259102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA07248148Medicaid
MD321511300Medicaid
DC010924700Medicaid
B94764Medicare UPIN
VA07248148Medicaid