Provider Demographics
NPI:1003017963
Name:TODD, JOSHUA WEBER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WEBER
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1819 W CLINCH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2435
Mailing Address - Country:US
Mailing Address - Phone:865-546-5111
Mailing Address - Fax:865-541-4018
Practice Address - Street 1:1819 W CLINCH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2435
Practice Address - Country:US
Practice Address - Phone:865-546-5111
Practice Address - Fax:865-541-4018
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47160207RI0011X, 207RC0000X
TXM4595207R00000X
NC2007-00329207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525406Medicaid
TN103I063118Medicare PIN