Healthcare Provider Details

I. General information

NPI: 1063418515
Provider Name (Legal Business Name): DARSHAN VIPIN TOLAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVER POINTE DR STE 100
CONROE TX
77304-2828
US

IV. Provider business mailing address

200 RIVER POINTE DR STE 100
CONROE TX
77304-2828
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-2555
  • Fax: 936-756-2534
Mailing address:
  • Phone: 936-756-2555
  • Fax: 936-756-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH6655
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH6655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: