Provider Demographics
NPI:1093791071
Name:STOLL, BRETT C (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:STOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-6927
Mailing Address - Fax:864-512-6687
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1250
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-224-2465
Practice Address - Fax:864-224-1146
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
SC21708207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC217081Medicaid
SCP00970781OtherRR MEDICARE
SCG51077Medicare UPIN
SCAA52507742Medicare PIN
SCP00970781OtherRR MEDICARE