Healthcare Provider Details

I. General information

NPI: 1194475863
Provider Name (Legal Business Name): PRABHJIT SINGH TOOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

144 ADDISON ST APT 605N
BOSTON MA
02128-5048
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2777
  • Fax:
Mailing address:
  • Phone: 732-669-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3013875
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: