Provider Demographics
NPI:1912932195
Name:KING, THEODORE J (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5559
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA56940207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4802321OtherUNITED HEALTH CARE
998296OtherNETWORK HEALTH
23713OtherHARVARD PILGRIM
MAN51575OtherBLUE CROSS BLUE SHIELD
35217834OtherCIGNA
056940OtherTUFTS COMMUNITY HEALTH PL
35217834OtherHEALTHSOURCE CMHC
1843219002OtherCIGNA
MA2057743Medicaid
290013485OtherRAILROAD MEDICARE
MAN51575OtherBLUE CROSS BLUE SHIELD
056940OtherTUFTS COMMUNITY HEALTH PL