MEDICARE: CARYN THEOBALD MD

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	207Q00000X	Family Medicine Physician	35-082516	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00245754	OTHER	OH	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396781233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARYN THEOBALD MD

Provider Business Mailing Address
First Line	:	442 W HIGH ST
Second Line	:
City	:	BRYAN
State	:	OH
Zip	:	43506-1681
Country	:	US
Telephone Number	:	419-636-4517
Fax Number	:	419-636-6438

Provider Business Practice Location Address
First Line	:	3926 NEW VISION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1712
Country	:	US
Telephone Number	:	419-445-2015
Fax Number	:	419-445-8102

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/12/2017

Similar Medicare Providers

1073508461 — DR. GERRY S EASTERDAY MD
Practice Location Address:

3978 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-672-4680
Practice Fax: 260-672-4685

1124063102 — DR. JUDY L. ZACHER M.D.
Practice Location Address:

3974 NEW VISION DRIVE
FORT WAYNE, IN
46845-1712

Practice Phone: 260-471-5980
Practice Fax: 260-471-5981

1861437642 — WOMEN CARING FOR WOMEN
Practice Location Address:

3974 NEW VISION DRIVE
FORT WAYNE, IN
46845-1712

Practice Phone: 260-471-5980
Practice Fax: 260-471-5981

1437168317 — MS. JACQUELINE MOORHEAD CHEN PT
Practice Location Address:

3982 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-483-9933
Practice Fax: 260-483-9931

1982799912 — MRS. VALERIE LYNN GUALDONI MA,CCC-SLP
Practice Location Address:

3926 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-373-2300
Practice Fax: 260-373-2335

1003982711 — MR. TODD MICHAEL SULLIVAN MPT
Practice Location Address:

3978 NEW VISION DR
FORT WAYNE, IN
46845-1712

Practice Phone: 260-373-9318
Practice Fax: 260-373-9301

Directions to “ CARYN THEOBALD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.