Provider Demographics
NPI:1922070309
Name:GENSLER, TODD W (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:GENSLER
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 1:397 LITTLE NECK RD
Mailing Address - Street 2:STE 100 3300 SOUTH BLDG
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-470-5570
Mailing Address - Fax:757-227-3377
Practice Address - Street 1:397 LITTLE NECK RD STE 120
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5774
Practice Address - Country:US
Practice Address - Phone:757-395-1600
Practice Address - Fax:757-961-9359
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012357932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00167034OtherMEDICARE RAILROAD
VA010103657Medicaid
P00167034OtherMEDICARE RAILROAD
F35083Medicare UPIN