Provider Demographics
NPI:1851438816
Name:EPSTEIN, TOLLY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLLY
Middle Name:ELIZABETH
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:GOLDBERG-EPSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2663
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:9002 N MERIDIAN ST STE 107
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5349
Practice Address - Country:US
Practice Address - Phone:317-848-9441
Practice Address - Fax:317-924-8239
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072065A207K00000X, 207K00000X
OH35-090183207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1127007OtherMEDICARE PTAN
IN200991060Medicaid
ININ1125007OtherMEDICARE PTAN
IN200991060Medicaid
IN200991060Medicaid