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NPI Code Detail

MEDICARE: STEPHEN M KOLLER MD

MEDICARE: STEPHEN M KOLLER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician042-0009220VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538197421
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN M KOLLER MD
Provider Business Mailing Address
First Line : 1119 BASIN HARBOR RD
Second Line :
City : BRIDPORT
State : VT
Zip : 05734-9570
Country : US
Telephone Number : 802-388-8851
Fax Number :
Provider Business Practice Location Address
First Line : 115 PORTER DR
Second Line : RADIOLOGY DEPARTMENT
City : MIDDLEBURY
State : VT
Zip : 05753-8423
Country : US
Telephone Number : 802-388-8851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 07/08/2007

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