MEDICARE: DR. TIMOTHY ALEXANDER TOLSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	94-00660	NC
2	207KA0200X	Allergy Physician	94-00660	NC
3	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	94-00660	NC
4	2080P0201X	Pediatric Allergy/Immunology Physician	94-00660	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811973522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY ALEXANDER TOLSON MD

Provider Business Mailing Address
First Line	:	410 E MAIN ST
Second Line	:	SUITE 202
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4495
Country	:	US
Telephone Number	:	252-338-0373
Fax Number	:	252-338-0073

Provider Business Practice Location Address
First Line	:	410 E MAIN ST
Second Line	:	SUITE 202
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4495
Country	:	US
Telephone Number	:	252-338-0373
Fax Number	:	252-338-0073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/13/2012

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