Provider Demographics
NPI:1376590661
Name:TODD, GREGORY (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:TODD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 WALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1350
Mailing Address - Country:US
Mailing Address - Phone:610-432-3183
Mailing Address - Fax:610-437-5180
Practice Address - Street 1:2428 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1350
Practice Address - Country:US
Practice Address - Phone:610-432-3183
Practice Address - Fax:610-437-5180
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009687L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01232202OtherCAPITAL BC
PA026023Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA01232202OtherCAPITAL BC