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General NPI Number Information
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NPI Number | 1023052438
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Entity Type | Individual
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Provider Name | PHILIP MARTIN STOLL D.O., D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 830 SOUTHAMPTON AVE SUITE 100
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City | NORFOLK
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State | VA
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Zip | 23510-1001
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Country | US
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Telephone | 757-683-8366
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Fax | 757-683-2589
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Provider Business Mailing Address
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Address Line | 4116 STEPHANIE BOYD DR
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City | CHESAPEAKE
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State | VA
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Zip | 23321-4423
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Country | US
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Telephone | 757-620-5158
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Fax | 757-465-3527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0102050003
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License Number State | VA
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