Provider Demographics
NPI:1750326385
Name:GROOM, TODD M (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:GROOM
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 1:8607 EASTHAVEN CT STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5217
Mailing Address - Country:US
Mailing Address - Phone:727-669-6800
Mailing Address - Fax:727-669-2540
Practice Address - Street 1:8607 EASTHAVEN CT STE 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5217
Practice Address - Country:US
Practice Address - Phone:727-669-6800
Practice Address - Fax:727-669-2540
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62936BMedicare PIN
FLH78663Medicare UPIN
FL62936AMedicare PIN