Provider Demographics
NPI:1457437543
Name:YARBORO, SR, THJEODORE LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:THJEODORE
Middle Name:LEON
Last Name:YARBORO, SR
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 1:755 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2530
Mailing Address - Country:US
Mailing Address - Phone:724-346-4124
Mailing Address - Fax:724-346-0766
Practice Address - Street 1:755 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2530
Practice Address - Country:US
Practice Address - Phone:724-346-4124
Practice Address - Fax:724-346-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007745E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006133980001Medicaid
PA0006133980001Medicaid
PAYA016524Medicare ID - Type Unspecified