Active NPI
Alan Teitelbaum, M.D.
- Psychiatry Physician
- San Rafael, CA
National Provider Identifier
1639392160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C30682
- Practice address
- 140 Spring Grove Ave
San Rafael, CA 94901-2638 - Phone
- (415) 302-5503
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C30682 | CA | Primary |
Addresses
Primary practice location
140 Spring Grove Ave
San Rafael, CA 94901-2638
Mailing address
140 Spring Grove Ave
San Rafael, CA 94901-2638
Phone (415) 302-5503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C30682 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431043200000",
"number": "1639392160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 SPRING GROVE AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012638",
"telephone_number": "415-302-5503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 SPRING GROVE AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012638",
"telephone_number": "415-302-5503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEITELBAUM",
"first_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-11",
"last_updated": "2015-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C30682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.