Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 94-00660 | NC |
N | 207KA0200X | Allergist | 94-00660 | NC |
N | 207RA0201X | Internist - Allergy & Immunology | 94-00660 | NC |
N | 2080P0201X | Pediatric Allergist | 94-00660 | NC |
NPI | 1811973522 |
---|---|
Provider Name | Dr. Timothy Alexander Tolson |
First Address | Elizabeth City, NC 27909-4495 |
Second Address | Elizabeth City, NC 27909-4495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2005 |
Last Update Date | 13/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6983580 | (05) | NC |
F80104 | (02) | NC |