Individual
TODD L VANDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 E MEDICAL LN STE 101, WEST COLUMBIA, SC 29169-4850
(803) 739-3660
(803) 739-3663
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7878
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
20877
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1904812
PHP
SC
05
—
208778
—
SC
01
—
340017144
RAILROAD MEDICARE
SC
Enumeration date
06/23/2005
Last updated
10/19/2020
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