Provider Demographics
NPI:1881835023
Name:TODD, MARK RICHARDSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARDSON
Last Name:TODD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6966
Mailing Address - Country:US
Mailing Address - Phone:410-543-8291
Mailing Address - Fax:410-341-6275
Practice Address - Street 1:106 MILFORD STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6966
Practice Address - Country:US
Practice Address - Phone:410-543-8291
Practice Address - Fax:410-341-6275
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2756103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64221800Medicaid
MDR10862Medicare UPIN
MD118P318GMedicare PIN