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General NPI Number Information
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NPI Number | 1336881986
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Entity Type | Individual
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Provider Name | TYLER TOLLESON MD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1800 ORLEANS ST
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City | BALTIMORE
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State | MD
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Zip | 21287-0010
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Country | US
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Telephone | 410-955-5987
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 MEDICAL CENTER DR
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City | HUNTINGTON
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State | WV
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Zip | 25701-3656
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Country | US
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Telephone | 304-691-1300
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 47954
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License Number State | AL
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Taxonomy #2
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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 | MD
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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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