Provider Demographics
NPI:1366507857
Name:TEITELBAUM, JACOB E (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:E
Last Name:TEITELBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:76-6326 KAHEIAU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3218
Mailing Address - Country:US
Mailing Address - Phone:410-573-5389
Mailing Address - Fax:410-266-6104
Practice Address - Street 1:7 BENMERE RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7235
Practice Address - Country:US
Practice Address - Phone:410-573-5389
Practice Address - Fax:410-590-3047
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2018-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD12803207R00000X
MDD0025812207R00000X
HI12803208VP0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21060OtherZIP CODE