Provider Demographics
NPI:1699712604
Name:WHITAKER, TODD E (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N BANK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5420
Mailing Address - Country:US
Mailing Address - Phone:614-451-7550
Mailing Address - Fax:614-451-8642
Practice Address - Street 1:2250 N BANK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-5420
Practice Address - Country:US
Practice Address - Phone:614-451-7550
Practice Address - Fax:614-451-8642
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180042380OtherRAILROAD MEDICARE
OH000000116977OtherANTHEM BC BS
OH368523492002OtherMEDICAL MUTUAL
OH0351310001OtherDMERC REGION B
OH2155902Medicaid
OH180042380OtherRAILROAD MEDICARE
OHH08987Medicare UPIN