Provider Demographics
NPI:1528390341
Name:ERMALOFF, TODD C
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:ERMALOFF
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 1:3100 CHANNEL DR # 314
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-364-3584
Mailing Address - Fax:240-218-0874
Practice Address - Street 1:3100 CHANNEL DR # 314
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7837
Practice Address - Country:US
Practice Address - Phone:907-364-3584
Practice Address - Fax:240-218-0874
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker