Provider Demographics
NPI:1134203110
Name:TOTH, THOMAS L (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:TOTH
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 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-433-5494
Mailing Address - Fax:707-385-2157
Practice Address - Street 1:1381 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3314
Practice Address - Country:US
Practice Address - Phone:707-433-5494
Practice Address - Fax:707-385-2157
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G687750Medicaid
00G687750Medicare ID - Type Unspecified
F12929Medicare UPIN