Healthcare Provider Details

I. General information

NPI: 1144875717
Provider Name (Legal Business Name): STOLL MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

IV. Provider business mailing address

1528 WALNUT ST STE 950
PHILADELPHIA PA
19102-3628
US

V. Phone/Fax

Practice location:
  • Phone: 267-273-1196
  • Fax: 267-273-1193
Mailing address:
  • Phone: 267-273-1196
  • Fax: 267-273-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MATTHEW STOLL
Title or Position: PROVIDER/OWNER
Credential:
Phone: 215-615-3020