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NPI Code Detail

MEDICARE: BRAD RUSSELL TOLAN PA-C

MEDICARE: BRAD RUSSELL TOLAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-10595NC

General Provider Information

NPI Number : 1043819741
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAD RUSSELL TOLAN PA-C
Provider Business Mailing Address
First Line : PO BOX 5105
Second Line :
City : BELFAST
State : ME
Zip : 04915-5100
Country : US
Telephone Number : 919-220-5255
Fax Number : 919-763-1055
Provider Business Practice Location Address
First Line : 3009 NEW BERN AVE
Second Line :
City : RALEIGH
State : NC
Zip : 27610-1214
Country : US
Telephone Number : 919-232-5020
Fax Number : 919-232-5021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2020
Last Update Date : 04/13/2026

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