Provider Demographics
NPI:1811973522
Name:TOLSON, TIMOTHY ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALEXANDER
Last Name:TOLSON
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 1:410 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4495
Mailing Address - Country:US
Mailing Address - Phone:252-338-0373
Mailing Address - Fax:252-338-0073
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4495
Practice Address - Country:US
Practice Address - Phone:252-338-0373
Practice Address - Fax:252-338-0073
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00660207K00000X, 207KA0200X, 207RA0201X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6983580Medicaid
NC2198828AMedicare ID - Type UnspecifiedOFFICE ONE
NC2198828BMedicare ID - Type UnspecifiedOFFICE TWO
NC6983580Medicaid