Provider Demographics
NPI:1427083500
Name:TOLBERT, ALFRED JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JAMES
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALFRED
Other - Middle Name:JAMES
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1100 SHADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4049
Mailing Address - Country:US
Mailing Address - Phone:610-269-6100
Mailing Address - Fax:
Practice Address - Street 1:1100 SHADOW WOOD DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-4049
Practice Address - Country:US
Practice Address - Phone:610-269-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000281L231H00000X
PASL000071L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019752570002Medicaid
PA30005307OtherKEYSTONE MERCY
PA0019753570001Medicaid
PA0342973000OtherSPEECH THERAPY HMO BLUE
PA302748OtherHEALTH AMERICA
PA4360649OtherAUD/SLP AETNA HMO
PA0342973000OtherSPEECH THERAPIST KHPE
PA20027710OtherAMERIHEALTH
PA0000567314OtherSPEECH THERAPIST PPO BLUE
PA7033420OtherAUD/SLP AETNA PPO/POS
PA0000208144OtherAUDIOLOGY BLUE CROSS/BLUE
PA0027032000OtherAUDIOLOGY HMO PER. CHOICE
PA0027032000OtherAUDIOLOGY KHPE
PA302748OtherHEALTH AMERICA