Provider Demographics
NPI:1124080700
Name:TOLER, ROD W (NAVY IDC)
Entity type:Individual
Prefix:
First Name:ROD
Middle Name:W
Last Name:TOLER
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7375
Mailing Address - Country:US
Mailing Address - Phone:757-345-0781
Mailing Address - Fax:
Practice Address - Street 1:618 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5815
Practice Address - Country:US
Practice Address - Phone:757-887-4016
Practice Address - Fax:757-884-7190
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman