Provider Demographics
NPI:1063418515
Name:TOLAT, DARSHAN VIPIN (MD)
Entity type:Individual
Prefix:
First Name:DARSHAN
Middle Name:VIPIN
Last Name:TOLAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 RIVER POINTE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2828
Mailing Address - Country:US
Mailing Address - Phone:936-756-2555
Mailing Address - Fax:936-756-2534
Practice Address - Street 1:200 RIVER POINTE DR
Practice Address - Street 2:STE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2828
Practice Address - Country:US
Practice Address - Phone:936-756-2555
Practice Address - Fax:936-756-2534
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6655207RN0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123465002Medicaid
TXF53141Medicare UPIN