Provider Demographics
NPI:1568650448
Name:JENNIFER CROWE TOLO, MD
Entity Type:Organization
Organization Name:JENNIFER CROWE TOLO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CROWE
Authorized Official - Last Name:TOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-898-8517
Mailing Address - Street 1:1722 211TH WAY NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4218
Mailing Address - Country:US
Mailing Address - Phone:425-898-8517
Mailing Address - Fax:425-458-4895
Practice Address - Street 1:1603 116TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3009
Practice Address - Country:US
Practice Address - Phone:425-458-4895
Practice Address - Fax:425-458-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119221Medicaid
WA1119221Medicaid
WAG48892Medicare UPIN