Provider Demographics
NPI:1508967563
Name:PABST, THEODORE SHUSTER III (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:SHUSTER
Last Name:PABST
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24 HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2006
Mailing Address - Country:US
Mailing Address - Phone:518-562-7557
Mailing Address - Fax:518-562-7559
Practice Address - Street 1:24 HAMMOND LN
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2076
Practice Address - Country:US
Practice Address - Phone:518-562-7557
Practice Address - Fax:518-562-7559
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1876402086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01276613Medicaid
NY020014148OtherRR MCARE INDIV
NYCM1443OtherRR MEDICARE GROUP