Provider Demographics
NPI:1740283399
Name:TODD, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
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 1:408 W ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4031
Mailing Address - Country:US
Mailing Address - Phone:864-227-9393
Mailing Address - Fax:864-227-9377
Practice Address - Street 1:408 W ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4031
Practice Address - Country:US
Practice Address - Phone:864-227-9393
Practice Address - Fax:864-227-9377
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11468207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC114682Medicaid
SCD908092811Medicare ID - Type UnspecifiedMEDICARE PROVIDER
SC114682Medicaid