1609848365 NPI number — HOWARD L STOLL MD

Table of content: HOWARD L STOLL MD (NPI 1609848365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609848365 NPI number — HOWARD L STOLL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLL
Provider First Name:
HOWARD
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1609848365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64715
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-805-2311
Provider Business Mailing Address Fax Number:
317-705-5060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14081-9706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-934-9001
Provider Business Practice Location Address Fax Number:
716-934-9005
Provider Enumeration Date:
02/06/2006

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: 2085R0202X , with the licence number:  203216-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000524423013 . This is a "BCBS WESTERN NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0156887 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00025860708 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01800926 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070621000063 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1609208 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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