Healthcare Provider Details

I. General information

NPI: 1033386461
Provider Name (Legal Business Name): CHARONE TOLBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BROADWAY ST
QUINCY IL
62301-2719
US

IV. Provider business mailing address

927 BROADWAY ST
QUINCY IL
62301-2719
US

V. Phone/Fax

Practice location:
  • Phone: 217-224-6423
  • Fax: 217-223-9370
Mailing address:
  • Phone: 217-224-6423
  • Fax: 217-223-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-132110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: