Provider Demographics
NPI:1235152208
Name:THOMAS C. TOLLI MD PA
Entity Type:Organization
Organization Name:THOMAS C. TOLLI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOLLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-321-9644
Mailing Address - Street 1:1001 37TH ST N
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6010
Mailing Address - Country:US
Mailing Address - Phone:727-321-9644
Mailing Address - Fax:727-327-0413
Practice Address - Street 1:1001 37TH ST N
Practice Address - Street 2:SUITE C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6010
Practice Address - Country:US
Practice Address - Phone:727-321-9644
Practice Address - Fax:727-327-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069472174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28368YMedicare ID - Type Unspecified