1699903021 NPI number — ASHLEY R TOLER D.O.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699903021 NPI number — ASHLEY R TOLER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLER
Provider First Name:
ASHLEY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699903021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 COURT ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24901-2516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-712-4948
Provider Business Mailing Address Fax Number:
304-512-3481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 COURT ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24901-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-712-4948
Provider Business Practice Location Address Fax Number:
304-512-3481
Provider Enumeration Date:
06/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 0102204361 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 2691 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810024989 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1699903021 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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