Provider Demographics
NPI:1043653371
Name:TOBE, LAUREN EVANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:EVANNA
Last Name:TOBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W 78TH ST
Mailing Address - Street 2:APARTMENT 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6513
Mailing Address - Country:US
Mailing Address - Phone:917-796-5470
Mailing Address - Fax:
Practice Address - Street 1:321 W 78TH ST
Practice Address - Street 2:APARTMENT 7A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6513
Practice Address - Country:US
Practice Address - Phone:917-796-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267889-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program