Provider Demographics
NPI:1396745402
Name:TODD, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:TODD
Suffix:
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 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 MCCLANAHAN ST SW
Practice Address - Street 2:SUITE300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1728
Practice Address - Country:US
Practice Address - Phone:540-982-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050404207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA060052159OtherRAILROAD MEDICARE PIN
VA6009786Medicaid
VA010248400Medicaid
VA6015310Medicaid
VACI6105OtherRR MEDICARE GROUP
VAF15603Medicare UPIN
VA060052159OtherRAILROAD MEDICARE PIN
VACI6105OtherRR MEDICARE GROUP
VA6009786Medicaid