Provider Demographics
NPI:1760537666
Name:MANSON, THEODORE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:THOMAS
Last Name:MANSON
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 1:8322 BELLONA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2065
Mailing Address - Country:US
Mailing Address - Phone:410-337-7900
Mailing Address - Fax:410-337-5321
Practice Address - Street 1:8322 BELLONA AVE STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2065
Practice Address - Country:US
Practice Address - Phone:410-337-7900
Practice Address - Fax:410-337-5321
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-243390207X00000X
MDD0065474207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0065474OtherMD LICENSE #