Provider Demographics
NPI:1821697533
Name:TOLLER ENTERPRISES LLC
Entity type:Organization
Organization Name:TOLLER ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:TOLLER
Authorized Official - Suffix:III
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:410-530-6612
Mailing Address - Street 1:2232 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2431
Mailing Address - Country:US
Mailing Address - Phone:667-207-3552
Mailing Address - Fax:443-885-9778
Practice Address - Street 1:2232 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2431
Practice Address - Country:US
Practice Address - Phone:667-207-3552
Practice Address - Fax:443-885-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty