Healthcare Provider Details

I. General information

NPI: 1093874307
Provider Name (Legal Business Name): STEPHANIE TODD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WIEHLE AVE STE 400
RESTON VA
20190-5159
US

IV. Provider business mailing address

1775 WIEHLE AVE STE 400
RESTON VA
20190-5159
US

V. Phone/Fax

Practice location:
  • Phone: 571-546-3461
  • Fax: 571-653-8468
Mailing address:
  • Phone: 571-546-3461
  • Fax: 571-653-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101246738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: