Basic Information
| Provider Information | |||||||||
| NPI: | 1740218478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEEL | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 NORTH 39TH STREET | ||||||||
| Address2: | MUTCH BUILDING, 6TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191042640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156628777 | ||||||||
| FaxNumber: | 2152433290 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 NORTH 39TH STREET | ||||||||
| Address2: | 7 FLOOR - MUTCH BLDG | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191042640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156628777 | ||||||||
| FaxNumber: | 2152433290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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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 | 207Q00000X | MD439514 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102451433 | 05 | PA | MEDICAID |