Provider Demographics
NPI:1053321059
Name:MCHUGH, THERESA WHITE (DO)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:WHITE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LANCASTER AVE
Mailing Address - Street 2:LANKENAU MSB, 1ST FLOOR
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:484-476-8150
Mailing Address - Fax:484-476-8151
Practice Address - Street 1:100 LANCASTER AVE
Practice Address - Street 2:LANKENAU MSB, 1ST FLOOR
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:484-476-8150
Practice Address - Fax:484-476-8151
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009514L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76572Medicare UPIN
PA065615HK1Medicare PIN
065615NCNMedicare ID - Type Unspecified
H76572Medicare UPIN
001446593OtherBLUE SHIELD PPO
2129956000OtherBLUE SHIELD HMO
7514571OtherCIGNA
002503522001OtherUNITED