Provider Demographics
NPI:1528066834
Name:TOLSTON, EVELYN (MD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:TOLSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:TOLSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:646-424-0400
Mailing Address - Fax:646-742-0092
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:646-424-0400
Practice Address - Fax:646-742-0092
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NY197743207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01600839Medicaid
NY01600839Medicaid
NY750861Medicare ID - Type Unspecified