1679837223 NPI number — BARBARA E TOLBERT BARBARA TOLBERT MED

Table of content: BARBARA E TOLBERT BARBARA TOLBERT MED (NPI 1679837223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679837223 NPI number — BARBARA E TOLBERT BARBARA TOLBERT MED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLBERT
Provider First Name:
BARBARA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BARBARA TOLBERT MED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EIDUSON
Provider Other First Name:
BARBARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BARBARA TOLBERT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679837223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5746 EAST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE VIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14085-9458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-627-9020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5746 EAST LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE VIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14085-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-627-9020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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