Provider Demographics
NPI:1518976786
Name:TODD, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 OSWEGO RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1662
Mailing Address - Country:US
Mailing Address - Phone:315-426-0200
Mailing Address - Fax:315-426-0283
Practice Address - Street 1:8100 OSWEGO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1662
Practice Address - Country:US
Practice Address - Phone:315-426-0200
Practice Address - Fax:315-426-0283
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2010-04-28
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Provider Licenses
StateLicense IDTaxonomies
NY198747-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01654806Medicaid
G26761Medicare UPIN