1255318036 NPI number — DR. DAVID W STOLLER M.D.

Table of content: DR. DAVID W STOLLER M.D. (NPI 1255318036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255318036 NPI number — DR. DAVID W STOLLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLLER
Provider First Name:
DAVID
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1255318036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94948-6102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-884-3418
Provider Business Mailing Address Fax Number:
415-883-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 CALIFORNIA ST
Provider Second Line Business Practice Location Address:
SUITE G350
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94118-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-600-2940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

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:  G50834 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 5855 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35464 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 30786 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25MA07189700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207K00000X , with the licence number: 036.103835 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0144894 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1255318036 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8169690 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300123273 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 111845 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200097670A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8940207 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300121756 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 8933500 . This is a "L&I, CVCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 93723288 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: G00508340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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