Healthcare Provider Details

I. General information

NPI: 1073708889
Provider Name (Legal Business Name): DOROTHY WEISS TOLCHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST AVE
CHARLESTON MA
02129
US

IV. Provider business mailing address

328 N RIVER ST
GUILFORD CT
06437-2426
US

V. Phone/Fax

Practice location:
  • Phone: 617-512-4502
  • Fax:
Mailing address:
  • Phone: 617-512-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL-229069
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number242973
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: