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General NPI Number Information
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NPI Number | 1174058275
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Entity Type | Individual
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Provider Name | TOBY DYLAN TERWILLIGER MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3050
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Country | US
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Telephone | 585-755-0192
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Fax |
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Provider Business Mailing Address
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Address Line | 143 MAPLE HILL FARM RD
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City | PENFIELD
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State | NY
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Zip | 14526-1713
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Country | US
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Telephone | 585-755-0192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 88520
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 88520
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 88520
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License Number State | GA
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