Provider Demographics
NPI:1649200544
Name:BAXTER, TODD ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALLYN
Last Name:BAXTER
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 1:2400 N PARK DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4425
Mailing Address - Country:US
Mailing Address - Phone:812-379-9524
Mailing Address - Fax:812-376-6383
Practice Address - Street 1:2400 N PARK DR
Practice Address - Street 2:SUITE 10
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4425
Practice Address - Country:US
Practice Address - Phone:812-379-9524
Practice Address - Fax:812-376-6383
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics