Provider Demographics
NPI:1376634477
Name:TODD D. GWIN, MD, PA
Entity type:Organization
Organization Name:TODD D. GWIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-583-5312
Mailing Address - Street 1:1330 BOILING SPRINGS ROAD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-583-5312
Mailing Address - Fax:864-582-1935
Practice Address - Street 1:1330 BOILING SPRINGS ROAD
Practice Address - Street 2:SUITE 2400
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-583-5312
Practice Address - Fax:864-582-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF0219OtherRAILROAD MEDICARE
SCGP1313Medicaid
SCGP1313Medicaid
SCGP1313Medicaid
=========OtherTAX IDENTIFICATION NUMBER