Provider Demographics
NPI:1063446268
Name:TOLOSA, DRAGO (MD)
Entity Type:Individual
Prefix:
First Name:DRAGO
Middle Name:
Last Name:TOLOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11503
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2503
Mailing Address - Country:US
Mailing Address - Phone:423-778-6575
Mailing Address - Fax:423-778-4231
Practice Address - Street 1:910 BLACKFORD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1405
Practice Address - Country:US
Practice Address - Phone:423-778-6575
Practice Address - Fax:423-778-4231
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN264352080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF70109Medicare UPIN