Provider Demographics
NPI:1184636300
Name:STEIN, THEODORE N (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:N
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 54679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0679
Mailing Address - Country:US
Mailing Address - Phone:310-967-1884
Mailing Address - Fax:310-967-1744
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-967-1884
Practice Address - Fax:310-967-1744
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG55567207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE95729Medicare UPIN