Provider Demographics
NPI:1124242748
Name:DOUGLAS TOZZOLI, DPM PC
Entity type:Organization
Organization Name:DOUGLAS TOZZOLI, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOZZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-432-9593
Mailing Address - Street 1:501 N 17TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5044
Mailing Address - Country:US
Mailing Address - Phone:610-432-9593
Mailing Address - Fax:
Practice Address - Street 1:501 N 17TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:610-432-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003307-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0808659000OtherAMERIHELATH 65
PA701216OtherPERSONAL CHOICE
PA02357900OtherCAPITAL BLUE CROSS
PA0808659000OtherKEYSTONE EAST
PA701216Medicare ID - Type UnspecifiedMEDICARE GROUP