Provider Demographics
NPI:1427051432
Name:TOLBERT, TODD GREGORY (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:GREGORY
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7260
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:300 20TH AVE N FL 789
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-1400
Practice Address - Fax:615-284-1420
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28543174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510070Medicaid
TN3881617Medicaid
TN6011834OtherBLUE CROSS-BLUE SHIELD
TN3881618Medicaid
TNP00669733OtherRR MEDICARE
TN3881618Medicare PIN
TN1510070Medicaid
TN6011834OtherBLUE CROSS-BLUE SHIELD