1518692409 NPI number — DR. LINCOLN STOLLER PHD, CHT, CCPCPR

Table of content: DR. LINCOLN STOLLER PHD, CHT, CCPCPR (NPI 1518692409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518692409 NPI number — DR. LINCOLN STOLLER PHD, CHT, CCPCPR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLLER
Provider First Name:
LINCOLN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, CHT, CCPCPR
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:
1518692409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 HIGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
BRITISH COLUMBIA
Provider Business Mailing Address Postal Code:
V8Z 5C8
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
BRITISH COLUMBIA
Provider Business Practice Location Address Postal Code:
V8Z 5C8
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
250-885-8677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2022

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: 101YM0800X , with the licence number:  3115 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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