Provider Demographics
NPI:1629096748
Name:STULL, TODD E (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:STULL
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 1:810 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6342
Mailing Address - Country:US
Mailing Address - Phone:814-946-5469
Mailing Address - Fax:814-946-4970
Practice Address - Street 1:810 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6342
Practice Address - Country:US
Practice Address - Phone:814-946-5469
Practice Address - Fax:814-946-4970
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036360E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012143420001Medicaid
PA602207F7PMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAE41920Medicare UPIN
PA0012143420001Medicaid