Provider Demographics
NPI:1104888122
Name:LORCH, THERESA (MD)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:LORCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:STE 655B JOHNSTON PROFESS BLDG
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6516
Mailing Address - Country:US
Mailing Address - Phone:410-554-4509
Mailing Address - Fax:410-554-6487
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:STE 655B JOHNSTON PROFESS BLDG
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6516
Practice Address - Country:US
Practice Address - Phone:410-554-4509
Practice Address - Fax:410-554-6487
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511010600Medicaid
MD511010600Medicaid
MDK45321LLMedicare ID - Type Unspecified