Healthcare Provider Details

I. General information

NPI: 1407066327
Provider Name (Legal Business Name): PATRICIA A. TODT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

150 E 293RD ST
WILLOWICK OH
44095-4548
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-6082
  • Fax:
Mailing address:
  • Phone: 440-347-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50 001512
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: