Basic Information
| Provider Information | |||||||||
| NPI: | 1871769638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEYGART | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 STATE STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568105 | ||||||||
| FaxNumber: | 8144568126 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 STATE STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144568105 | ||||||||
| FaxNumber: | 8144568126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OT012129 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS014970 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1024794610001 | 05 | PA | MEDICAID |