Healthcare Provider Details

I. General information

NPI: 1972633840
Provider Name (Legal Business Name): DAMON ALARIC TOHTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ROBINSON ST
BINGHAMTON NY
13904-1735
US

IV. Provider business mailing address

425 ROBINSON ST
BINGHAMTON NY
13904-1735
US

V. Phone/Fax

Practice location:
  • Phone: 504-473-4372
  • Fax:
Mailing address:
  • Phone: 504-473-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number245067
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number245067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: