Provider Demographics
NPI:1750488003
Name:DRASIN, TODD ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ELLIS
Last Name:DRASIN
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 1:2500 MERCED ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4201
Mailing Address - Country:US
Mailing Address - Phone:510-454-7506
Mailing Address - Fax:
Practice Address - Street 1:2500 MERCED ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4201
Practice Address - Country:US
Practice Address - Phone:510-454-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-15
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-05
Provider Licenses
StateLicense IDTaxonomies
CAA772862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ361ZMedicare PIN
CAHA3227Medicare UPIN