Individual
DR. THEODORE WILLIS LAETSCH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(267) 425-0126
Mailing address
3401 CIVIC CENTER BLVD STE M975, PHILADELPHIA, PA 19104-4319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD436327
PA
2080P0207X
Pediatric Hematology & Oncology Physician
MD436327
PA
2080P0207X
Pediatric Hematology & Oncology Physician
P6853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13339796
—
CO
Enumeration date
01/26/2007
Last updated
02/19/2024
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