Provider Demographics
NPI:1588658314
Name:TODD, STUART K (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:K
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 JEREMY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1518
Mailing Address - Country:US
Mailing Address - Phone:252-443-4361
Mailing Address - Fax:252-443-0096
Practice Address - Street 1:1508 JEREMY LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1518
Practice Address - Country:US
Practice Address - Phone:252-443-4361
Practice Address - Fax:252-443-0096
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19554208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983585Medicaid
NC8983585Medicaid
NCC86788Medicare UPIN