Provider Demographics
NPI:1912904186
Name:TOBOLOWSKY, DAVID MARTONE (M D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTONE
Last Name:TOBOLOWSKY
Suffix:
Gender:M
Credentials:M D
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 165923
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-5923
Mailing Address - Country:US
Mailing Address - Phone:305-667-1101
Mailing Address - Fax:786-206-0987
Practice Address - Street 1:9601 SW 123RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2540
Practice Address - Country:US
Practice Address - Phone:305-667-1101
Practice Address - Fax:786-206-0987
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-03
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME356592084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066399900Medicaid
FL95875OtherBLUE CROSS BLUE SHIELD
FLD63644Medicare UPIN
FLD63644Medicare UPIN