Provider Demographics
NPI:1275892499
Name:KAMAL N. TOLIA, M.D., P.A.
Entity Type:Organization
Organization Name:KAMAL N. TOLIA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:NALIN
Authorized Official - Last Name:TOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-362-3626
Mailing Address - Street 1:6005 EASTRIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5019
Mailing Address - Country:US
Mailing Address - Phone:432-362-3626
Mailing Address - Fax:432-366-3363
Practice Address - Street 1:6005 EASTRIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5019
Practice Address - Country:US
Practice Address - Phone:432-362-3626
Practice Address - Fax:432-366-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5697207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0984270Medicaid
TX0984270Medicaid