Provider Demographics
NPI:1306826102
Name:COLONNA, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MICHAEL
Last Name:COLONNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-990-6565
Practice Address - Fax:301-990-8525
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0055661207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00020966OtherMEDICARE RAILROAD NUMBER
DC873857Medicare PIN
P00020966OtherMEDICARE RAILROAD NUMBER