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General NPI Number Information
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NPI Number | 1861381246
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Entity Type | Organization
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Legal Business Name | TOLLER ENTERPRISES LLC
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1818 NEWTON ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-1017
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Country | US
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Telephone | 202-328-7400
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Fax | 202-328-0421
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Provider Business Mailing Address
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Address Line | 2232 E MONUMENT ST
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City | BALTIMORE
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State | MD
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Zip | 21205-2431
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Country | US
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Telephone | 667-207-3552
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Fax | 443-885-9778
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Authorized Official
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Title or Position | OWNER
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Name | WALTER LEWIS TOLLER
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Credential |
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Telephone | 667-207-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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