Theodore Vandam M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A24788 Issued in CA

Legal business name

THEODORE VANDAM M.D.

Practice address

665 Camino de Los Mares
Ste 210
San Clemente, CA 92673-2859

Phone

(949) 240-6772

Fax

(949) 240-6841

NPI assigned

Jun 8, 2007

Last updated

Jul 28, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theodore Vandam, M.D.NPI 1871527226

Title

President

Phone

(949) 240-6772

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theodore Richard Van Dam, M.D.

  • Internal Medicine Physician
  • San Clemente, CA
  • NPI 1871527226
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1699978304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "STE 210",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859",
            "telephone_number": "949-240-6772",
            "fax_number": "949-240-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "STE 210",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732859",
            "telephone_number": "949-240-6772",
            "fax_number": "949-240-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE VANDAM M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "VANDAM",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-240-6772",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A24788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A247880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Barbara Marie Thomas, PSY.D.
• Christina Joy Thompson, DMD

• Internal Medicine Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.