Basic Information
| Provider Information | |||||||||
| NPI: | 1114976602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASKO | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1871 SAVAGE ROAD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666308 | ||||||||
| FaxNumber: | 8438049883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1871 SAVAGE ROAD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666308 | ||||||||
| FaxNumber: | 8438049883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 18304 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 183045 | 05 | SC | MEDICAID |