Healthcare Provider Details

I. General information

NPI: 1568969988
Provider Name (Legal Business Name): PATRICIA STOLLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6379 CENTER DR
NORFOLK VA
23502-4102
US

IV. Provider business mailing address

627 INGLESIDE RD
NORFOLK VA
23502-4201
US

V. Phone/Fax

Practice location:
  • Phone: 757-470-5810
  • Fax: 757-467-4173
Mailing address:
  • Phone: 757-641-4838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101272665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: