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1417928318

NPI Code Detail

MEDICARE: RANDY SCOTT STOLOFF MD

MEDICARE: RANDY SCOTT STOLOFF 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	207K00000X	Allergy & Immunology Physician	ME142529	FL
2	207K00000X	Allergy & Immunology Physician	D0088620	MD
3	207K00000X	Allergy & Immunology Physician	2014-02205	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	NCL232A	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417928318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY SCOTT STOLOFF MD

Provider Business Mailing Address
First Line	:	200 FORSYTHE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5426
Country	:	US
Telephone Number	:	910-824-7619
Fax Number	:	910-824-7754

Provider Business Practice Location Address
First Line	:	200 FORSYTHE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5426
Country	:	US
Telephone Number	:	910-824-7619
Fax Number	:	910-824-7754

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	03/22/2022

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Directions to “ RANDY SCOTT STOLOFF MD” Practice Location

Language	Start Address	Practice Location

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