Provider Demographics
NPI:1699758268
Name:WRIGHT, THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:WRIGHT
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 1:740 S LIMESTONE
Mailing Address - Street 2:A301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-6494
Mailing Address - Fax:859-257-4682
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:A301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-4682
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68195208G00000X
CAA82758208G00000X
WI45267208G00000X
KY39329208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64097017Medicaid
H84003Medicare UPIN
KY64097017Medicaid
KY0028146Medicare PIN