Healthcare Provider Details

I. General information

NPI: 1477580702
Provider Name (Legal Business Name): EDWARD A THEURKAUF JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OLD LANCASTER RD SUITE 320
BRYN MAWR PA
19010-3231
US

IV. Provider business mailing address

825 OLD LANCASTER RD SUITE 320
BRYN MAWR PA
19010-3231
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-3800
  • Fax: 610-527-0334
Mailing address:
  • Phone: 610-527-3800
  • Fax: 610-527-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD024843
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: