Provider Demographics
NPI:1417114588
Name:BARBOSA, TODD MICHAEL
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 OLD CLARKSVILLE SPGFLD RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-8905
Mailing Address - Country:US
Mailing Address - Phone:805-794-4636
Mailing Address - Fax:
Practice Address - Street 1:1817A MADISON ST
Practice Address - Street 2:STE 1
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2930
Practice Address - Country:US
Practice Address - Phone:931-551-1795
Practice Address - Fax:931-551-1798
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46896207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology