Provider Demographics
NPI:1033143565
Name:TOLL, RICHARD BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRUCE
Last Name:TOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-382-7500
Mailing Address - Fax:518-382-7572
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-382-7500
Practice Address - Fax:518-382-7572
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11117OtherMVP
NY5945680OtherAETNA
NY000401552001OtherBSNENY
NY10002050OtherCDPHP
NY47363OtherGHI/HMO
NY200197OtherSENIOR WHOLE HEALTH
NY28N031OtherEMPIRE BC
NY070302000077OtherFIDELIS
NY00491167Medicaid
NY200197OtherSENIOR WHOLE HEALTH
NY000401552001OtherBSNENY