Healthcare Provider Details

I. General information

NPI: 1538239603
Provider Name (Legal Business Name): ROY B STOLLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIDGE RD SUITE 12
CHADDS FORD PA
19317-9784
US

IV. Provider business mailing address

222 SYKES LN
WALLINGFORD PA
19086-6337
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-3001
  • Fax: 610-459-0399
Mailing address:
  • Phone: 610-357-8784
  • Fax: 610-459-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberOS006048E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: