Provider Demographics
NPI:1518966860
Name:TOLSON, GRAEME MEREDITH (MD)
Entity Type:Individual
Prefix:
First Name:GRAEME
Middle Name:MEREDITH
Last Name:TOLSON
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 1:18275 N 59TH AVE
Mailing Address - Street 2:BLDG K SUITE 162
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1254
Mailing Address - Country:US
Mailing Address - Phone:602-547-8184
Mailing Address - Fax:602-547-8339
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG K SUITE 162
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1254
Practice Address - Country:US
Practice Address - Phone:602-547-8184
Practice Address - Fax:602-547-8339
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91778Medicare UPIN
Z24465Medicare PIN