Basic Information
| Provider Information | |||||||||
| NPI: | 1629041314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 GREAT BAY RD | ||||||||
| Address2: | |||||||||
| City: | GREENLAND | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038402161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034316045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | CATHOLIC MEDICAL CENTER | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036636478 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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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 | 207P00000X | 12360 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 142910000 | 05 | ME | MEDICAID | 2130726 | 05 | MA | MEDICAID | AA79991 | 01 | HARVARD PILGRIM | OTHER | 01Y007667NH03 | 01 | NH | ANTHEM | OTHER | 01Y007667NH02 | 01 | NH | ANTHEM | OTHER | 4138008 | 01 | MVP | OTHER | 30206504 | 05 | NH | MEDICAID | P00384960 | 01 | RAILROAD MEDICARE | OTHER | 000000038818 | 01 | BMC HEALTHNET PLAN | OTHER |