MEDICARE: LAURIE TOLIN MD

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
1	207N00000X	Dermatology Physician	MD016388E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070015849	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0031830	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1184685935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE TOLIN MD

Provider Business Mailing Address
First Line	:	100 CHURCH RD
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-2316
Country	:	US
Telephone Number	:	610-642-1806
Fax Number	:	610-645-5783

Provider Business Practice Location Address
First Line	:	100 CHURCH RD
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-2316
Country	:	US
Telephone Number	:	610-642-1806
Fax Number	:	610-645-5783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	10/18/2010

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Directions to “ LAURIE TOLIN MD” Practice Location

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