Provider Demographics
NPI:1225030208
Name:GWIN, TODD D (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:GWIN
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 1:1520 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-583-6381
Mailing Address - Fax:864-583-5337
Practice Address - Street 1:1520 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316
Practice Address - Country:US
Practice Address - Phone:864-583-6381
Practice Address - Fax:864-583-5337
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1313Medicaid
180018827OtherRAILROAD MEDICARE
1050550001OtherDMERC
SC14321Medicaid