Provider Demographics
NPI:1730187501
Name:LEMMON, TODD (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:LEMMON
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 1:270 GOOSEPOND RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3104
Mailing Address - Country:US
Mailing Address - Phone:220-564-7945
Mailing Address - Fax:220-564-7946
Practice Address - Street 1:1717 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1362
Practice Address - Country:US
Practice Address - Phone:220-564-7970
Practice Address - Fax:220-564-7971
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062731207V00000X
OH35.062731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314169Medicaid
OHH213711Medicare PIN