Individual
STEFAN JOHN TOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE C100, GREENVILLE, SC 29615-3593
(864) 454-7422
(864) 454-8265
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
16789
SC
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
16789
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167893
—
SC
01
—
576007863133
BLUE CHOICE OF SC
SC
01
—
576007863178
BCBS OF SC
SC
01
—
P00384026
RR MEDICARE
SC
Enumeration date
08/31/2006
Last updated
11/10/2022
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