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NPI Code Detail

MEDICARE: TODD L VANDENBERG MD

MEDICARE: TODD L VANDENBERG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician20877SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1340017144OTHERSCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31904812OTHERSCPHP

General Provider Information

NPI Number : 1558367623
Entity Type Code : Individual
Provider Name (Legal Business Name) : TODD L VANDENBERG MD
Provider Business Mailing Address
First Line : 330 SEVEN SPRINGS WAY
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-5098
Country : US
Telephone Number : 615-920-7878
Fax Number : 615-920-8775
Provider Business Practice Location Address
First Line : 222 E MEDICAL LN STE 101
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-4850
Country : US
Telephone Number : 803-739-3660
Fax Number : 803-739-3663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 10/19/2020

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Directions to “ TODD L VANDENBERG MD” Practice Location

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