Individual
DENOTTA SHAVONN TEAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 DIVISION ST, BALTIMORE, MD 21217-3121
(410) 728-4176
(410) 728-4412
Mailing address
3106 LAUREL VIEW DR, ABINGDON, MD 21009-2626
(410) 515-7747
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0001369
MD
Other
Enumeration date
08/10/2005
Last updated
11/30/2010
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