Provider Demographics
NPI:1629182159
Name:TODOROV, IRINA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:TODOROV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 RICHMOND RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3719
Mailing Address - Country:US
Mailing Address - Phone:216-448-4325
Mailing Address - Fax:216-448-8615
Practice Address - Street 1:1950 RICHMOND RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3719
Practice Address - Country:US
Practice Address - Phone:216-448-4325
Practice Address - Fax:216-448-8615
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92316207Q00000X
OH35.122355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.122355OtherLICENSE