Provider Demographics
NPI:1619616760
Name:TOLLER ENTERPRISES LLC
Entity Type:Organization
Organization Name:TOLLER ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:TOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-868-4107
Mailing Address - Street 1:2439 E LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2562
Mailing Address - Country:US
Mailing Address - Phone:443-868-4107
Mailing Address - Fax:443-885-9778
Practice Address - Street 1:2439 E LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2562
Practice Address - Country:US
Practice Address - Phone:443-868-4107
Practice Address - Fax:443-885-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty