Basic Information
| Provider Information | |||||||||
| NPI: | 1396877791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7253 AMBASSADOR RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212442710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434361116 | ||||||||
| FaxNumber: | 4434361256 | ||||||||
| Practice Location | |||||||||
| Address1: | 2002 MEDICAL PKWY | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102662770 | ||||||||
| FaxNumber: | 4108416251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | D64922 | MD | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1073 | 01 | MD | AAD BCBS REGIONAL PLANS | OTHER | CA1932 | 01 | MD | RR MEDICARE AAD GROUP PTAN | OTHER | 1073 | 01 | MD | AAD BLUE CHOICE | OTHER | CN6292 | 01 | MD | RR MEDICARE SHIPLEYS GROUP PTAN | OTHER | P00897482 | 01 | MD | RR MEDICARE AAD PROVIDER PTAN | OTHER | S645 | 01 | MD | AAD BCBS | OTHER | 171724 | 01 | MD | MEDICARE ARA PTAN | OTHER | 412929600 | 05 | MD | MEDICAID | P00895755 | 01 | MD | RR MEDICARE SHIPLEYS PROVIDER PTAN | OTHER |