Basic Information
| Provider Information | |||||||||
| NPI: | 1184979684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEELMAN | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 728 BATTERY PL | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223143827 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177244133 | ||||||||
| FaxNumber: | 6176437941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 06/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01012549990 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD467563 | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 30639 | WV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 291151 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 103630297 | 05 | PA | MEDICAID | 14429156 | 01 | PA | CAQH | OTHER |