Provider Demographics
NPI:1487693107
Name:CLAIR, THEODORE WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:WILLIAM
Last Name:CLAIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:864 COUNTY LINE RD
Mailing Address - Street 2:GLENBROOK MEDICAL BLDG
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-0560
Mailing Address - Fax:610-527-8683
Practice Address - Street 1:864 COUNTY LINE RD
Practice Address - Street 2:GLENBROOK MEDICAL BLDG
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-0560
Practice Address - Fax:610-527-8683
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
PA007687EMD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC2508527OtherDEA FED
AC2508527OtherDEA FED