Provider Demographics
NPI:1255381455
Name:TOLAND, KENT C (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:C
Last Name:TOLAND
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 1:24076 SE STARK ST STE 310
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3386
Mailing Address - Country:US
Mailing Address - Phone:503-492-6510
Mailing Address - Fax:
Practice Address - Street 1:24076 SE STARK ST STE 310
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3386
Practice Address - Country:US
Practice Address - Phone:503-492-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18530208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059241Medicaid
340014753OtherMEDICARE RAILROAD
OR139313Medicare PIN
F67384Medicare UPIN