Provider Demographics
NPI:1841272283
Name:TOLIS, GEORGE JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:TOLIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:COX 6 SUITE 630
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-9280
Mailing Address - Fax:617-726-5804
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:COX 6 SUITE 630
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-643-9280
Practice Address - Fax:617-726-5804
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY224934208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02439834Medicaid
H79709Medicare UPIN
NY02439834Medicaid