Provider Demographics
NPI:1700869997
Name:BELANGER, THEODORE ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ANDREW
Last Name:BELANGER
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:PO BOX 262409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2409
Mailing Address - Country:US
Mailing Address - Phone:972-772-8767
Mailing Address - Fax:972-473-3929
Practice Address - Street 1:3164 HORIZON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7805
Practice Address - Country:US
Practice Address - Phone:972-772-8767
Practice Address - Fax:972-772-8780
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00556207XS0117X
NC2003-00556207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134HWMedicaid
NC2028198BMedicare PIN
NCH76380Medicare UPIN
NC89134HWMedicaid