Basic Information
Provider Information
NPI: 1376821900
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOOKE
FirstName: MICHAEL
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 219 S WASHINGTON ST
Address2:  
City: EASTON
State: MD
PostalCode: 216012913
CountryCode: US
TelephoneNumber: 4108221000
FaxNumber: 4107703836
Practice Location
Address1: 219 S WASHINGTON ST
Address2:  
City: EASTON
State: MD
PostalCode: 216012913
CountryCode: US
TelephoneNumber: 4108221000
FaxNumber: 4107703836
Other Information
ProviderEnumerationDate: 08/01/2011
LastUpdateDate: 08/01/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0048137MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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