Provider Demographics
NPI:1861925174
Name:TOTH, THEODORE
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:TOTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 FAIRFAX DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1773
Mailing Address - Country:US
Mailing Address - Phone:703-525-8863
Mailing Address - Fax:571-748-4257
Practice Address - Street 1:3833 FAIRFAX DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1773
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:571-748-4257
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101268836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program