Individual
GREGORY RUSSELL TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
410 W 10TH AVE, COLUMBUS, OH 43210-1240
(614) 685-5695
(614) 293-4726
Mailing address
700 ACKERMAN RD STE 570, COLUMBUS, OH 43202-1579
(614) 293-5502
(614) 293-4726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005332RX
OH
363A00000X
Physician Assistant
5601011558
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0255265
—
OH
Enumeration date
10/12/2017
Last updated
08/17/2023
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