Provider Demographics
NPI:1518181817
Name:TOLGE, DAVID (RPA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TOLGE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 STATE HWY 30
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7532
Mailing Address - Country:US
Mailing Address - Phone:518-842-2663
Mailing Address - Fax:518-842-4861
Practice Address - Street 1:5010 STATE HWY 30
Practice Address - Street 2:SUITE 205
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-842-2663
Practice Address - Fax:518-842-4861
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400034920OtherMEDICARE
NYP39447OtherMEDICARE UPIN
AKP39447Medicare UPIN