MEDICARE: DR. THEODORE MICHAEL PARSONS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11116	MT
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD447990	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265450209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE MICHAEL PARSONS M.D.

Provider Business Mailing Address
First Line	:	132 S 10TH ST
Second Line	:	SUITE 285K
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5244
Country	:	US
Telephone Number	:	215-503-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 S 10TH ST
Second Line	:	SUITE 285K
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5244
Country	:	US
Telephone Number	:	215-503-5642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/09/2013

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