Provider Demographics
NPI:1093973091
Name:TODORIC, KRISTA M (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:TODORIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 BENT CREEK BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-791-2640
Mailing Address - Fax:717-791-2646
Practice Address - Street 1:1700 BENT CREEK BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-791-2640
Practice Address - Fax:717-791-2646
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106746207K00000X, 207R00000X
PAMD442011207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025830110003Medicaid