Basic Information
| Provider Information | |||||||||
| NPI: | 1033197512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REMANDABAN | ||||||||
| FirstName: | TEODULO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5115 BERNARD DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240184357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Practice Location | |||||||||
| Address1: | 5115 BERNARD DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240184357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403450289 | ||||||||
| FaxNumber: | 5403459569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101028711 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1033197512 | 05 | VA | MEDICAID |