Healthcare Provider Details

I. General information

NPI: 1518192004
Provider Name (Legal Business Name): STEVEN MATTHEW STOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST SUITE 950
PHILADELPHIA PA
19102-3604
US

IV. Provider business mailing address

1528 WALNUT ST SUITE 950
PHILADELPHIA PA
19102-3604
US

V. Phone/Fax

Practice location:
  • Phone: 215-300-3772
  • Fax: 267-273-1193
Mailing address:
  • Phone: 215-300-3772
  • Fax: 267-273-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD443713
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD443713
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: