Provider Demographics
NPI:1801884887
Name:ZUSMER, TODD RUSSELL (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:RUSSELL
Last Name:ZUSMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 SCUFFLETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7204
Practice Address - Country:US
Practice Address - Phone:864-329-0029
Practice Address - Fax:864-329-8125
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7932207Q00000X
SC1377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC013773Medicaid
SCP00892907OtherRAILROAD MEDICARE
SCAA55846067Medicare PIN