Provider Demographics
NPI:1922398742
Name:HARITON, THEODORE NICOLA (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:NICOLA
Last Name:HARITON
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 1:65344 E ROCKY MESA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-1692
Mailing Address - Country:US
Mailing Address - Phone:520-818-3833
Mailing Address - Fax:520-818-3831
Practice Address - Street 1:65344 E ROCKY MESA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1692
Practice Address - Country:US
Practice Address - Phone:520-818-3833
Practice Address - Fax:520-818-3831
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-19999207VC0200X
AZ33858207VC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine