Provider Demographics
NPI:1164467940
Name:VAN TOL, LOIS JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:JEAN
Last Name:VAN TOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46 PRINCE ST.
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1023
Mailing Address - Country:US
Mailing Address - Phone:585-351-2893
Mailing Address - Fax:585-216-1258
Practice Address - Street 1:46 PRINCE ST.
Practice Address - Street 2:SUITE 2004
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1023
Practice Address - Country:US
Practice Address - Phone:585-351-2893
Practice Address - Fax:585-216-1258
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY236200-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02676704Medicaid
J300058861Medicare PIN
NYG36678Medicare UPIN
NYRA6816Medicare PIN