Healthcare Provider Details

I. General information

NPI: 1730379942
Provider Name (Legal Business Name): TODD LANSFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 MEDCOM ST
NORTH CHARLESTON SC
29406-9188
US

IV. Provider business mailing address

9100 MEDCOM ST
NORTH CHARLESTON SC
29406-9188
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-2663
  • Fax: 843-764-3577
Mailing address:
  • Phone: 843-572-2663
  • Fax: 843-764-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number94-06761
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: