Provider Demographics
NPI:1841406766
Name:KREITZER, TODD VINCENT (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:VINCENT
Last Name:KREITZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 KANAWHA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1207
Mailing Address - Country:US
Mailing Address - Phone:304-768-4567
Mailing Address - Fax:304-768-2277
Practice Address - Street 1:4815 KANAWHA AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1207
Practice Address - Country:US
Practice Address - Phone:304-768-4567
Practice Address - Fax:304-768-2277
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.001750207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4262731Medicare PIN