Provider Demographics
NPI:1134124134
Name:TOLGE, CELINA FRANCES (MD)
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:FRANCES
Last Name:TOLGE
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:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-432-0335
Mailing Address - Fax:307-432-0341
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-432-0335
Practice Address - Fax:307-432-0341
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO336372084N0400X
WY6308A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1134124134Medicaid
CO01336379Medicaid
W23932Medicare PIN
CO01336379Medicaid
E79214Medicare UPIN