1639249956 NPI number — J S TODER

Table of content: DR. TOD H DRUCKER D.M.D. (NPI 1295768729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639249956 NPI number — J S TODER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TODER
Provider First Name:
J
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TODER
Provider Other First Name:
J SCOTT
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639249956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02940-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-6011
Provider Business Mailing Address Fax Number:
401-421-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 ATWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-421-6011
Provider Business Practice Location Address Fax Number:
401-421-9088
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  MD6321 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3200105 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000426 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1136 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 774339 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: R10981 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 002267 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4268 . This is a "RI BC" identifier . This identifiers is of the category "OTHER".




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