MEDICARE: SYAM B STOLL MD

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	208D00000X	General Practice Physician	21729	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9486104	OTHER	WV	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346214913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYAM B STOLL MD

Provider Business Mailing Address
First Line	:	PO BOX 4190
Second Line	:
City	:	BARBOURSVILLE
State	:	WV
Zip	:	25504-4190
Country	:	US
Telephone Number	:	304-399-4405
Fax Number	:	304-399-2526

Provider Business Practice Location Address
First Line	:	2827 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1435
Country	:	US
Telephone Number	:	304-399-7182
Fax Number	:	304-523-7738

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	05/11/2018

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