Laetsch, Theodore Willis

Laetsch, Theodore Willis is an individual health care provider with primary practice located at 3401 Civic Center Blvd , Philadelphia PA 19104-4319. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Laetsch, Theodore Willis can be contacted via phone (267) 425-0126.

Contact Information

Primary practice address
3401 Civic Center Blvd Philadelphia PA 19104-4319
Phone: (267) 425-0126
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology 2080P0207X P6853 Texas
Allopathic & Osteopathic Physicians / Pediatric Hematology-Oncology 2080P0207X MD436327 Pennsylvania
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD436327 Pennsylvania

Profile Details

NPI number 1154477834
LBN Legal business name Laetsch, Theodore Willis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2007
Last updated Feb 19th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154477834 NPPES
Colorado MEDICAID 13339796

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