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DR. SIMON DANIEL XAVIER THEBAULT M.D.
NPI 1174258305
Psychiatry & Neurology - Neurology in Philadelphia, PA

Active since July 21, 2022
3400 CIVIC CENTER BLVD S, 2ND FLOOR, PHILADELPHIA, PA 19104(215) 316-5151 Get Directions Write a Review

NPPES record last updated: September 28, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 28, 2022, Jul 21, 2022 (2 updates tracked since 2022).

About Dr. Simon Daniel Xavier Thebault M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SIMON DANIEL XAVIER THEBAULT M.D. (NPI 1174258305) is an individual neurology provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (MD478091) and active in the NPI registry since July 2022.

NPPES Registry Identity

NPI1174258305
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameDR. SIMON DANIEL XAVIER THEBAULTCredential: M.D.
Location Address3400 CIVIC CENTER BLVD S, 2ND FLOORPhiladelphia, PA 19104
Mailing Address24 Cricket Ave, Apt 408Ardmore, PA 19003 · (267) 588-2244
Phone(215) 316-5151
Sole ProprietorNo
Enumeration DateJuly 21, 2022
Last NPPES UpdateSeptember 28, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2022
✔ NPI 1174258305 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in PA · MD478091
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
3400 CIVIC CENTER BLVD S, Philadelphia, PA 19104
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Simon Thebault's NPI number?

The NPI number for Simon Thebault is 1174258305. It was assigned to this individual provider in the NPPES registry on July 21, 2022.

Where is Simon Thebault located?

Simon Thebault practices at 3400 Civic Center Blvd S 2nd Floor, Philadelphia, PA 19104. The listed phone number is (215) 316-5151.

What is Simon Thebault's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

When was this NPI record last updated?

The NPPES record for Simon Thebault was last updated on September 28, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.