Provider Demographics
NPI:1720040611
Name:TAPPER, THEODORE SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:SAMUEL
Last Name:TAPPER
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 1:522 HOWE RD
Mailing Address - Street 2:
Mailing Address - City:MERION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1107
Mailing Address - Country:US
Mailing Address - Phone:610-664-3590
Mailing Address - Fax:610-664-8672
Practice Address - Street 1:522 HOWE RD
Practice Address - Street 2:
Practice Address - City:MERION
Practice Address - State:PA
Practice Address - Zip Code:19066-1107
Practice Address - Country:US
Practice Address - Phone:610-664-3590
Practice Address - Fax:610-664-8672
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012099E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics