Healthcare Provider Details

I. General information

NPI: 1972521979
Provider Name (Legal Business Name): THEODORE PHILLIPS CHAMBERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 CORPORATE DRIVE #125
BALTIMORE MD
21236-6901
US

IV. Provider business mailing address

PO BOX 416026
BOSTON MA
02241-6026
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-9729
  • Fax: 410-931-2133
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0101056643
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number0101056643
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101056643
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101056643
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number0101056643
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0101056643
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number0101056643
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: