Provider Demographics
NPI:1023238557
Name:DAVID TOLL MD
Entity type:Organization
Organization Name:DAVID TOLL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-748-2348
Mailing Address - Street 1:1394 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1829
Mailing Address - Country:US
Mailing Address - Phone:802-748-2348
Mailing Address - Fax:802-748-5561
Practice Address - Street 1:1394 MAIN ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1829
Practice Address - Country:US
Practice Address - Phone:802-748-2348
Practice Address - Fax:802-748-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0002104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006628Medicaid