Provider Demographics
NPI:1558465252
Name:THEODORU, RADU M (MD)
Entity Type:Individual
Prefix:DR
First Name:RADU
Middle Name:M
Last Name:THEODORU
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 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12916 CONAMAR DR STE 204
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2773
Practice Address - Country:US
Practice Address - Phone:301-791-0600
Practice Address - Fax:410-367-2023
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD366961100Medicaid
882MMedicare ID - Type Unspecified
G09247Medicare UPIN