Active NPI
Stewart Edward Teal, M.D.
- Child & Adolescent Psychiatry Physician
- Sacramento, CA
National Provider Identifier
1902809460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- C30919
- Practice address
- 811 Grand Ave Ste D
Sacramento, CA 95838-3466 - Phone
- (916) 922-9868
- Fax
- (916) 922-7342
- NPI assigned
- May 27, 2005
- 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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | C30919 | MI | Primary |
Addresses
Primary practice location
811 Grand Ave Ste D
Sacramento, CA 95838-3466
Mailing address
811 Grand Ave Ste D
Sacramento, CA 95838-3466
Phone (916) 922-9868
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005583-000 | Other | CA | MAGELLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C30919 | MI | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380240000000",
"number": "1902809460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 GRAND AVE STE D",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958383466",
"telephone_number": "916-922-9868",
"fax_number": "916-922-7342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 GRAND AVE STE D",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958383466",
"telephone_number": "916-922-9868",
"fax_number": "916-922-7342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEAL",
"first_name": "STEWART",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-27",
"last_updated": "2013-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MI",
"license": "C30919",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "005583-000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.