MEDICARE: PETER KENNETH STOLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	09293	MD

General Provider Information

NPI Number	:	1164043717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER KENNETH STOLL

Provider Business Mailing Address
First Line	:	710 RESERVE CHAMPION DR
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-5716
Country	:	US
Telephone Number	:	646-373-7129
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 DARNESTOWN RD STE 102
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-2604
Country	:	US
Telephone Number	:	240-200-5305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	05/05/2020

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Directions to “ PETER KENNETH STOLL ” Practice Location

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