Provider Demographics
NPI:1114976602
Name:VASKO, TODD R (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:VASKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 SAVAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-766-6308
Mailing Address - Fax:843-804-9883
Practice Address - Street 1:1871 SAVAGE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-766-6308
Practice Address - Fax:843-804-9883
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18304208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC183045Medicaid
G29408Medicare UPIN
6995Medicare ID - Type Unspecified
SC183045Medicaid