Provider Demographics
NPI:1790732188
Name:TROY, TODD DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:TROY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-383-7660
Mailing Address - Fax:614-383-7665
Practice Address - Street 1:445 ROCKY FORK BLVD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3336
Practice Address - Country:US
Practice Address - Phone:614-383-7660
Practice Address - Fax:614-383-7665
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003518RX363AM0700X, 363A00000X
OH50.003518363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMT1416898OtherDEA NUMBER
NC2766344Medicare PIN
NCQ69897Medicare UPIN