Provider Demographics
NPI:1457447682
Name:LOCKE, TODD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WILLIAM
Last Name:LOCKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2758 LANDON ROAD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-4806
Mailing Address - Fax:216-297-3233
Practice Address - Street 1:1611 SOUTH GREEN ROAD
Practice Address - Street 2:SUITE 213
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-381-1520
Practice Address - Fax:221-629-7323
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-052123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC03331Medicare UPIN
OHLO0614832Medicare PIN