Provider Demographics
NPI:1275842494
Name:WALDRON, THEODORE C (DO)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:C
Last Name:WALDRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:SUGARLOAF
Mailing Address - State:PA
Mailing Address - Zip Code:18249-3806
Mailing Address - Country:US
Mailing Address - Phone:570-578-3778
Mailing Address - Fax:
Practice Address - Street 1:146 HICKORY RD
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3806
Practice Address - Country:US
Practice Address - Phone:570-578-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS OO4266L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine