Provider Demographics
NPI:1396857017
Name:SCHMIDGALL, TODD (DPM)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:SCHMIDGALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 ADDINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5318 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1012
Practice Address - Country:US
Practice Address - Phone:513-421-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3213 S213E00000X
WV10405213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00831630OtherRAILROAD MEDICARE WEST VIRGINIA
KY7100128610Medicaid
WV3810016994Medicaid
OHP00206189Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY7100128610Medicaid
KYP300027263Medicare PIN
OHSC4124292Medicare PIN
WV3810016994Medicaid