Provider Demographics
NPI:1609860337
Name:TODD, MICHAEL MCLAIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MCLAIN
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:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1701
Practice Address - Country:US
Practice Address - Phone:703-723-5700
Practice Address - Fax:703-723-5778
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235935207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00307175OtherRR MEDICARE
VA010075424Medicaid
VA004630M19Medicare PIN
VAP00307175OtherRR MEDICARE