Provider Demographics
NPI:1063480630
Name:WHITFORD, THEODORE C (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:C
Last Name:WHITFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 STONEWOOD DR
Mailing Address - Street 2:303
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7380
Mailing Address - Country:US
Mailing Address - Phone:724-935-6280
Mailing Address - Fax:
Practice Address - Street 1:6001 STONEWOOD DR
Practice Address - Street 2:303
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7380
Practice Address - Country:US
Practice Address - Phone:724-935-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051146L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
547193OtherHIGHMARK
PA0017496590008Medicaid
PA026688Medicare PIN
PA0017496590008Medicaid