Provider Demographics
NPI:1700935699
Name:TOLMAN, PHILLIP WILLIAM (PA)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:WILLIAM
Last Name:TOLMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17190
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-7190
Mailing Address - Country:US
Mailing Address - Phone:702-560-2889
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:511 N HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3132
Practice Address - Country:US
Practice Address - Phone:843-761-0936
Practice Address - Fax:843-761-0938
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103958363A00000X
SC1194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0519PAMedicaid
SCP00834849OtherRAILROAD MEDICARE ID-RSFPN
SCP00834849OtherRAILROAD MEDICARE ID-RSFPN
AA16925551Medicare PIN
SCAA16929223Medicare PIN