Basic Information
| Provider Information | |||||||||
| NPI: | 1376509331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOUSSAINT | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372457100 | ||||||||
| FaxNumber: | 9372457999 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE CHILDRENS PLAZA | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
| FaxNumber: | 9376415408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35056560 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2612980 | 05 | OH | MEDICAID |