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General NPI Number Information
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NPI Number | 1962454991
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Entity Type | Individual
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Provider Name | SANDRA R TOLLEY MD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 1900 ELECTRIC RD
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City | SALEM
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State | VA
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Zip | 24153-7474
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Country | US
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Telephone | 540-776-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4504 STARKEY RD SUITE 200
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City | ROANOKE
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State | VA
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Zip | 24014-4040
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Country | US
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Telephone | 540-776-8337
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Fax | 540-776-6856
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101051873
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License Number State | VA
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