Healthcare Provider Details

I. General information

NPI: 1346214913
Provider Name (Legal Business Name): SYAM B STOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 5TH AVE
HUNTINGTON WV
25702-1435
US

IV. Provider business mailing address

PO BOX 4190
BARBOURSVILLE WV
25504-4190
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-7182
  • Fax: 304-523-7738
Mailing address:
  • Phone: 304-399-4405
  • Fax: 304-399-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21729
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: