Provider Demographics
NPI:1285688747
Name:CONLIFFE, THEODORE DAVID JR (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:DAVID
Last Name:CONLIFFE
Suffix:JR
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 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:609-677-7003
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:999 ROUTE 73 N STE 301&401
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1227
Practice Address - Country:US
Practice Address - Phone:800-321-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065466L2081P2900X
NJ25MA073558002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2678030OtherAETNA
NJ2740687OtherAETNA
6719765OtherCIGNA
PA0768790000OtherIBC
NJ2124376000OtherIBC
NJ2740687OtherAETNA
6719765OtherCIGNA
NJ2124376000OtherIBC
6719765OtherCIGNA
PA0768790000OtherIBC