Provider Demographics
NPI:1225242696
Name:FOLEY, THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:FOLEY
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 1:425 N 21ST ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2223
Mailing Address - Country:US
Mailing Address - Phone:717-695-6553
Mailing Address - Fax:855-383-3233
Practice Address - Street 1:425 N 21ST ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2223
Practice Address - Country:US
Practice Address - Phone:717-695-6553
Practice Address - Fax:855-383-3233
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4383022082S0105X, 208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD438302OtherSTATE LICENSE#
PA12386129OtherCAQH#
PA1851794283OtherGROUP NPI