Healthcare Provider Details

I. General information

NPI: 1538241013
Provider Name (Legal Business Name): MATTHEW LAURENCE STOLL M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S DEPARTMENT OF PEDIATRICS
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

1600 7TH AVE S DEPARTMENT OF PEDIATRICS
BIRMINGHAM AL
35233-1711
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3795
  • Fax:
Mailing address:
  • Phone: 205-934-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number30926
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: