Provider Demographics
NPI:1245452499
Name:TODD, WILLIAM UPTON IV (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:UPTON
Last Name:TODD
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6713
Mailing Address - Country:US
Mailing Address - Phone:609-441-2147
Mailing Address - Fax:
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-441-8063
Practice Address - Fax:609-441-2107
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186092207ZP0105X
NJ28MA08742100207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3787519000OtherAMERIHEALTH OF NEW JERSEY
NJ0230413Medicaid
NJ1245452499OtherHORIZON NJ HEALTH
NJ3787519000OtherAMERIHEALTH OF NEW JERSEY