Provider Demographics
NPI:1386635076
Name:A J TOLBERT & ASSOCIATES INC
Entity Type:Organization
Organization Name:A J TOLBERT & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-269-6100
Mailing Address - Street 1:1100 SHADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4049
Mailing Address - Country:US
Mailing Address - Phone:610-269-6100
Mailing Address - Fax:610-873-6687
Practice Address - Street 1:1100 SHADOW WOOD DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-4049
Practice Address - Country:US
Practice Address - Phone:610-269-6100
Practice Address - Fax:610-873-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT00281L231H00000X
PASL000071L235Z00000X
PAD00378332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101427710 0001Medicaid
PA30005306OtherKEYSTONE MERCY
PA4360649OtherAETNA AUD
PA0001511227OtherINDEP BLUE CROSS
PA0027032000OtherKEYSTONE HEALTH PLAN EAST
PA0342973000OtherKEYSTONE HEALTH PLAN EAST
PA101422710 0002Medicaid
PA101427710 0003Medicaid
PA0001511228OtherIBC PPO INDEP BLUE CROSS
PA0342973000OtherKEYSTONE HEALTH PLAN EAST
PA101427710 0003Medicaid