Healthcare Provider Details

I. General information

NPI: 1376821900
Provider Name (Legal Business Name): MICHAEL C TOOKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

IV. Provider business mailing address

219 S WASHINGTON ST
EASTON MD
21601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1000
  • Fax: 410-770-3836
Mailing address:
  • Phone: 410-822-1000
  • Fax: 410-770-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0048137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: