Provider Demographics
NPI:1699730267
Name:TEATER, B SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:B
Middle Name:SCOTT
Last Name:TEATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4097
Mailing Address - Country:US
Mailing Address - Phone:937-435-9013
Mailing Address - Fax:937-435-1458
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 260
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4097
Practice Address - Country:US
Practice Address - Phone:937-435-9013
Practice Address - Fax:937-435-1458
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35075368T207Q00000X
OH35075368T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190543Medicaid
OH2190543Medicaid
OH4015594Medicare PIN
OH4015592Medicare PIN
OH4015595Medicare PIN
OH4015596Medicare PIN
080157834Medicare PIN
OH4015593Medicare PIN