Healthcare Provider Details

I. General information

NPI: 1699913178
Provider Name (Legal Business Name): ADAM JARED STOLLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3118
US

IV. Provider business mailing address

163 LIBBEY PKWY SUITE 301
WEYMOUTH MA
02189-3118
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-4224
  • Fax: 781-335-0429
Mailing address:
  • Phone: 781-337-4224
  • Fax: 781-335-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberBB5078654-AS-143-AN
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberBB5078654-AS143-AN
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: