MEDICARE: JASON W. TODD 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	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	200400988	NC
2	2084V0102X	Vascular Neurology Physician	200400988	NC
3	2084N0400X	Neurology Physician	200400988	NC

General Provider Information

NPI Number	:	1780656751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON W. TODD MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16645 BIRKDALE COMMONS PKWY
Second Line	:	STE 200 G
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5669
Country	:	US
Telephone Number	:	704-302-8555
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	07/15/2024

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