Provider Demographics
NPI:1417170044
Name:TOTH, NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:TOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 BAYVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6344
Mailing Address - Country:US
Mailing Address - Phone:510-521-7398
Mailing Address - Fax:510-568-0225
Practice Address - Street 1:24100 AMADOR
Practice Address - Street 2:SUITE 250 WINTON WELLNESS CENTER
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-266-1700
Practice Address - Fax:510-266-1762
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9054Medicaid
CAG9054Medicare ID - Type Unspecified
A58789Medicare UPIN