Provider Demographics
NPI:1780656751
Name:TODD, JASON W (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:W
Last Name:TODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16645 BIRKDALE COMMONS PKWY
Practice Address - Street 2:STE 200 G
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5669
Practice Address - Country:US
Practice Address - Phone:704-302-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004009882084S0012X, 2084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7605570OtherAETNA
NC7355570OtherCIGNA
NCD5924OtherMEDCOST
NC232009OtherMEDICARE PTAN, GROUP
NC89137J2Medicaid
NC137J2OtherBCBSNC
NC804842OtherPARTNERS MEDICARE CHOICE
NC7355570OtherCIGNA
NC2028749AMedicare PIN
NC804842OtherPARTNERS MEDICARE CHOICE