Healthcare Provider Details

I. General information

NPI: 1811973522
Provider Name (Legal Business Name): TIMOTHY ALEXANDER TOLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E MAIN ST SUITE 202
ELIZABETH CITY NC
27909-4495
US

IV. Provider business mailing address

410 E MAIN ST SUITE 202
ELIZABETH CITY NC
27909-4495
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-0373
  • Fax: 252-338-0073
Mailing address:
  • Phone: 252-338-0373
  • Fax: 252-338-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number94-00660
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number94-00660
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number94-00660
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number94-00660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: