Provider Demographics
NPI:1700064482
Name:PHILIP TODARO, D.O., P.C.
Entity Type:Organization
Organization Name:PHILIP TODARO, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TODARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-246-4888
Mailing Address - Street 1:1516 E EVANS ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4363
Mailing Address - Country:US
Mailing Address - Phone:229-246-4888
Mailing Address - Fax:229-246-4881
Practice Address - Street 1:1516 E EVANS ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4363
Practice Address - Country:US
Practice Address - Phone:229-246-4888
Practice Address - Fax:229-246-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015330208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000024527AMedicaid
GA1659384816OtherBLUE CROSS/BLUE SHIELD
GA511G700371Medicare PIN
GA000024527AMedicaid