Provider Demographics
NPI:1174647465
Name:TOLAND, KIRK CAMERON (MED)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:CAMERON
Last Name:TOLAND
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SOUTH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1528
Mailing Address - Country:US
Mailing Address - Phone:609-703-9190
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor