Provider Demographics
NPI:1225098619
Name:NEUBERGER, TODD J (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:J
Last Name:NEUBERGER
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:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-991-4644
Mailing Address - Fax:866-342-0133
Practice Address - Street 1:555 N NEW BALLAS RD
Practice Address - Street 2:DIV SURG VASCULAR, STE 265
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6825
Practice Address - Country:US
Practice Address - Phone:314-991-4644
Practice Address - Fax:866-342-0133
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109902208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208298901Medicaid