Provider Demographics
NPI:1215610605
Name:TODARO, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:TODARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VALLEY RIVER WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2127
Mailing Address - Country:US
Mailing Address - Phone:717-226-0785
Mailing Address - Fax:
Practice Address - Street 1:1011 VALLEY RIVER WAY STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2127
Practice Address - Country:US
Practice Address - Phone:541-342-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA217607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant