Provider Demographics
NPI:1558462648
Name:ALBALA, TODD STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEVEN
Last Name:ALBALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TODD
Other - Middle Name:S
Other - Last Name:ALBALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1080 FIRST COLONIAL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2406
Mailing Address - Country:US
Mailing Address - Phone:757-395-6630
Mailing Address - Fax:
Practice Address - Street 1:1080 FIRST COLONIAL RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-395-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401164207R00000X
SC37965207R00000X
VA0101267072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13747OtherBC/BS OF NC
SCNC1101Medicaid
NCP00198352OtherRAILROAD MEDICARE
NC1558462648Medicaid
NC8913747Medicaid
NCP00198352OtherRAILROAD MEDICARE
NCE93633Medicare UPIN
SCSC5685Medicare PIN
NC1558462648Medicaid