Provider Demographics
NPI:1013555671
Name:TOLAN, MERRITT MCCOY (MD)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:MCCOY
Last Name:TOLAN
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 1:9404 HIGHWAY 78 STE 100
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3909
Mailing Address - Country:US
Mailing Address - Phone:843-737-0437
Mailing Address - Fax:843-789-3053
Practice Address - Street 1:9404 HIGHWAY 78 STE 100
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3909
Practice Address - Country:US
Practice Address - Phone:843-737-0437
Practice Address - Fax:843-789-3053
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16788207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC167884Medicaid