Provider Demographics
NPI:1144209040
Name:TOLANEY, POOJA D (MD)
Entity type:Individual
Prefix:MRS
First Name:POOJA
Middle Name:D
Last Name:TOLANEY
Suffix:
Gender:F
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:PO BOX 732973 SUITE 215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 S MAIN ST STE 1600
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7663
Practice Address - Country:US
Practice Address - Phone:817-702-3401
Practice Address - Fax:817-702-6924
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3605207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043001OtherPHYSICIAN SURGEON LICENSE
CT004236007Medicaid
CT37407OtherCONTROLLED SUBSTANCE
CT043001OtherPHYSICIAN SURGEON LICENSE
440001705Medicare ID - Type Unspecified