Provider Demographics
NPI:1285807800
Name:SPIRO, THEODORE ERICH (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ERICH
Last Name:SPIRO
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 1:11 BENJAMIN TRL
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-9747
Mailing Address - Country:US
Mailing Address - Phone:609-737-5118
Mailing Address - Fax:609-737-8503
Practice Address - Street 1:11 BENJAMIN TRL
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-9747
Practice Address - Country:US
Practice Address - Phone:609-737-5118
Practice Address - Fax:609-737-8503
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053883600207R00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center