Healthcare Provider Details

I. General information

NPI: 1649276403
Provider Name (Legal Business Name): KENNETH M TOTO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BRYN MAWR AVE STE 200
BRYN MAWR PA
19010-3123
US

IV. Provider business mailing address

101 S BRYN MAWR AVE STE 200
BRYN MAWR PA
19010-3123
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-9500
  • Fax: 610-527-9529
Mailing address:
  • Phone: 610-527-9500
  • Fax: 610-527-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000337L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: