Provider Demographics
NPI:1144225343
Name:SEVERIN, TODD DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DANA
Last Name:SEVERIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 NORRIS CANYON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5440
Mailing Address - Country:US
Mailing Address - Phone:925-830-8823
Mailing Address - Fax:925-866-6610
Practice Address - Street 1:5801 NORRIS CANYON RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5406
Practice Address - Country:US
Practice Address - Phone:925-830-8823
Practice Address - Fax:925-866-6610
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71183207WX0009X
CAOG711830207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180046438OtherRAIL ROAD MEDICARE
CAZZZ057067OtherBLUE CROSS
CAOGP164916Medicaid
CAZZZ05706ZOtherBLUE SHIELD
CAZZZ05706ZOtherBLUE SHIELD
CAZZZ057067OtherBLUE CROSS