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General NPI Number Information
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NPI Number | 1972831337
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Entity Type | Organization
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Legal Business Name | THEODORE S NAM MD PC
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 219 REECEVILLE ROAD
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City | COATESVILLE
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State | PA
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Zip | 19320-0000
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Country | US
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Telephone | 610-383-4990
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Fax | 610-383-4989
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Provider Business Mailing Address
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Address Line | 219 REECEVILLE ROAD
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City | COATESVILLE
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State | PA
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Zip | 19320-0000
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Country | US
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Telephone | 610-383-4990
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Fax | 610-383-4989
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THEODORE S NAM
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Credential | MD
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Telephone | 610-383-4990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD436926
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License Number State | PA
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