Provider Demographics
NPI:1437319266
Name:MAGRO, TODD KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:KEITH
Last Name:MAGRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2179 ASHLEY PHOSPHATE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4180
Mailing Address - Country:US
Mailing Address - Phone:843-718-3168
Mailing Address - Fax:843-414-7948
Practice Address - Street 1:2179 ASHLEY PHOSPHATE RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-718-3168
Practice Address - Fax:843-414-7948
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC309912084P0802X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC309918Medicaid
SC309918Medicaid