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NPI Code Detail

MEDICARE: DR. GWENDOLYN TODD-HOUSTON MD

MEDICARE: DR. GWENDOLYN TODD-HOUSTON 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
1208000000XPediatrics PhysicianL3207SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598876773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GWENDOLYN TODD-HOUSTON MD
Provider Business Mailing Address
First Line : 51 NASSAU STREET
Second Line :
City : CHARLESTON
State : SC
Zip : 29403
Country : US
Telephone Number : 843-722-4112
Fax Number : 843-722-4802
Provider Business Practice Location Address
First Line : 51 NASSAU ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29403-5513
Country : US
Telephone Number : 843-722-4112
Fax Number : 843-577-8960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/21/2015

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