Healthcare Provider Details

I. General information

NPI: 1679292098
Provider Name (Legal Business Name): DANIELLE REBECCA TOLSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 MEADOWRIDGE CENTER DR
ELKRIDGE MD
21075-6528
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 410-872-1600
  • Fax: 410-799-1595
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: