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General NPI Number Information
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NPI Number | 1215177498
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Entity Type | Individual
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Provider Name | ADREA D THEODORE M.D., M.P.H.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 1206-B VAUGHN ROAD
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City | BURLINGTON
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State | NC
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Zip | 27216
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Country | US
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Telephone | 336-228-0813
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Fax | 336-228-7087
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Provider Business Mailing Address
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Address Line | 1206-B VAUGHN ROAD P. O. BOX 673
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City | BURLINGTON
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State | NC
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Zip | 27216
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Country | US
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Telephone | 336-228-0813
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Fax | 336-228-7087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 9701880
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License Number State | NC
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