Provider Demographics
NPI:1558467761
Name:NAM, THEODORE S (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:S
Last Name:NAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4855 S PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5632
Mailing Address - Country:US
Mailing Address - Phone:301-295-4095
Mailing Address - Fax:
Practice Address - Street 1:4855 S PALMER RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5632
Practice Address - Country:US
Practice Address - Phone:301-295-4095
Practice Address - Fax:301-295-0046
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4369262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023989170001Medicaid
PA1023989170001Medicaid