Organization
TOLLER ENTERPRISES LLC
Active
Other names
Autumn Lake Healthcare at Loch Raven
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER LEWIS TOLLER (OWNER)
(667) 207-3552
Entity
Organization
Contact information
Practice address
8720 EMGE RD, BALTIMORE, MD 21234-3504
(410) 668-1961
(410) 882-3114
Mailing address
2232 E MONUMENT ST, BALTIMORE, MD 21205-2431
(469) 208-4651
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/30/2025
Last updated
07/01/2025
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