Provider Demographics
NPI:1639249956
Name:TODER, J S
Entity Type:Individual
Prefix:
First Name:J
Middle Name:S
Last Name:TODER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:J SCOTT
Other - Middle Name:
Other - Last Name:TODER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6300
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-6300
Mailing Address - Country:US
Mailing Address - Phone:401-421-6011
Mailing Address - Fax:401-421-9088
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-421-6011
Practice Address - Fax:401-421-9088
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6321207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3200105OtherUNITED HEALTH CARE
RI9000426Medicaid
1136OtherNEIGHBORHOOD HEALTH
774339OtherTUFTS
R10981OtherHEALTHNET
002267OtherBLUE CHIP
4268OtherRI BC
1136OtherNEIGHBORHOOD HEALTH