MEDICARE: DR. MARGARET THEODORE M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0031671	FL

General Provider Information

NPI Number	:	1891732640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET THEODORE M.D.

Provider Business Mailing Address
First Line	:	5420 WEBB RD
Second Line	:	SUITE B-1
City	:	TAMPA
State	:	FL
Zip	:	33615-3250
Country	:	US
Telephone Number	:	813-886-0548
Fax Number	:	813-886-0890

Provider Business Practice Location Address
First Line	:	5420 WEBB RD
Second Line	:	SUITE B-1
City	:	TAMPA
State	:	FL
Zip	:	33615-3250
Country	:	US
Telephone Number	:	813-886-0548
Fax Number	:	813-886-0890

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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