MEDICARE: TODD SEVERSON 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
1	207P00000X	Emergency Medicine Physician	016311	ME

General Provider Information

NPI Number	:	1396717146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD SEVERSON MD

Provider Business Mailing Address
First Line	:	100 GANNETT DR STE C
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-5900
Country	:	US
Telephone Number	:	207-828-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 FODEN RD STE 3
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-1718
Country	:	US
Telephone Number	:	207-523-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/26/2024

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Directions to “ TODD SEVERSON MD” Practice Location

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