Provider Demographics
NPI:1669439949
Name:TOLLEY, CAROLYN S (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:S
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ALLEN COIT RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01050-9770
Mailing Address - Country:US
Mailing Address - Phone:413-667-3050
Mailing Address - Fax:
Practice Address - Street 1:1850 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1921
Practice Address - Country:US
Practice Address - Phone:413-536-3800
Practice Address - Fax:413-536-3830
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
MA150324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000000007943OtherHEALTHNET
CT0101500324MA01OtherANTHEM BCBS
MA750037OtherCONNECTICARE
MA17141OtherHEALTH NEW ENGLAND
MAJ16425OtherBCBS
MA1013150OtherCIGNA
MA1859609Medicaid
MA150324OtherTUFTS HEALTH PLAN
MA63270OtherHARVARD PILGRIM
MA150324OtherTUFTS HEALTH PLAN
MA1859609Medicaid