Provider Demographics
NPI:1245354752
Name:ANDERSON, THEODORE STARBUCK JR (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:STARBUCK
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:122 N ELM ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2878
Mailing Address - Country:US
Mailing Address - Phone:336-334-5601
Mailing Address - Fax:336-334-5657
Practice Address - Street 1:122 N ELM ST
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2878
Practice Address - Country:US
Practice Address - Phone:336-334-5601
Practice Address - Fax:336-334-5657
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC20092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11271OtherBLUE CROSS BLUE SHIELD
NC3403407Medicaid
NCF48696Medicare UPIN