Provider Demographics
NPI:1306064514
Name:TEBOR, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:TEBOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6723 WHITTIER AVE
Mailing Address - Street 2:SUITE 405-C
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4522
Mailing Address - Country:US
Mailing Address - Phone:703-908-9230
Mailing Address - Fax:703-908-8834
Practice Address - Street 1:6723 WHITTIER AVE
Practice Address - Street 2:SUITE 405-C
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4522
Practice Address - Country:US
Practice Address - Phone:703-908-9230
Practice Address - Fax:703-908-8834
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010444312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491648Medicare ID - Type Unspecified