Provider Demographics
NPI:1770634669
Name:GOLDFARAB, THEODORE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:GEORGE
Last Name:GOLDFARAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1188 SEA LARKE DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4453
Mailing Address - Country:US
Mailing Address - Phone:760-723-8946
Mailing Address - Fax:760-723-8946
Practice Address - Street 1:1188 SEA LARKE DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4453
Practice Address - Country:US
Practice Address - Phone:760-695-8946
Practice Address - Fax:760-723-8946
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH022043207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology