MEDICARE: DR. CHARLES BRADIE TONER M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	057505	GA
2	208D00000X	General Practice Physician	057505	GA
3	207ND0900X	Dermatopathology Physician	057505	GA
4	207ND0101X	MOHS-Micrographic Surgery Physician	D0067264	MD
5	207ND0101X	MOHS-Micrographic Surgery Physician	D67264	MD
6	207NP0225X	Pediatric Dermatology Physician	057505	GA
7	174400000X	Specialist	057505	GA
8	207ND0101X	MOHS-Micrographic Surgery Physician	0101054810	VA
9	207ND0101X	MOHS-Micrographic Surgery Physician	057505	GA
10	207N00000X	Dermatology Physician	057505	GA
11	207ZD0900X	Dermatopathology (Pathology) Physician	057505	GA

NPI Number	:	1508846817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES BRADIE TONER M.D.

Provider Business Mailing Address
First Line	:	6410 ROCKLEDGE DR
Second Line	:	STE 300
City	:	BETHESDA
State	:	MD
Zip	:	20817-7811
Country	:	US
Telephone Number	:	240-515-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501BACKLICK ROAD
Second Line	:	SUITE 110 & 120
City	:	SPRINGFIELD
State	:	VA
Zip	:	22151-3960
Country	:	US
Telephone Number	:	703-705-7505
Fax Number	:	866-990-3880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	11/10/2025

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039