Provider Demographics
NPI:1831161314
Name:DELBRIDGE, THEODORE RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:RICHARD
Last Name:DELBRIDGE
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:PO BOX 751069
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, 3ED-313
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:ECU PHYSICIANS EMERGENCY MEDICINE AT PCMH
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-4757
Practice Address - Fax:252-744-4125
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044801L174400000X
NC2006-00362207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903616Medicaid
NC1418POtherBCBSNC
PA001292198Medicaid
PA634177HWUMedicare ID - Type Unspecified
NC1418POtherBCBSNC
NC5903616Medicaid