Doctor Name: | DR. THEODORE JAMES COLTERELLI |
NPI Number: | 1609077106 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | OS014368 |
Business Practice Address: | 84-1 Ferne Blvd Drexel Hill, PA - 190265510 |
Business Phone Number: | 2672594607 |
Business Fax Number: | 6103282036 |
Mailing Address: | 84-1 Ferne Blvd, DREXEL HILL |
State: | PA |
Postal Code: | 190265510 |
Phone Number: | 2672594607 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2007 |
NPI Last Update Date: | 07/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | OS014368 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |