Provider Demographics
NPI:1326158106
Name:WASHKO, TODD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ROBERT
Last Name:WASHKO
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 1:1022 1ST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007
Mailing Address - Country:US
Mailing Address - Phone:205-663-9950
Mailing Address - Fax:205-620-0864
Practice Address - Street 1:1022 1ST STREET NORTH
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007
Practice Address - Country:US
Practice Address - Phone:205-663-9950
Practice Address - Fax:205-620-0864
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35870208000000X
IL036-116327208000000X
MO18678208000000X
CO42247208000000X
LA025542208000000X
AL37785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17974071Medicaid
SC358703Medicaid
H72485Medicare UPIN
SC358703Medicaid
SCSC12932389Medicare PIN