Provider Demographics
NPI:1154412526
Name:HOUK, THEODORE CARL (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:CARL
Last Name:HOUK
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 1:7402 YORK ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7522
Mailing Address - Country:US
Mailing Address - Phone:410-296-5200
Mailing Address - Fax:410-296-5263
Practice Address - Street 1:7402 YORK RD STE 301
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7522
Practice Address - Country:US
Practice Address - Phone:410-296-5200
Practice Address - Fax:410-296-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158081700Medicaid
MD4348Medicare ID - Type Unspecified