Provider Demographics
NPI:1104852516
Name:STOLARSKYJ, ALEX T (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:T
Last Name:STOLARSKYJ
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 4460
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0460
Mailing Address - Country:US
Mailing Address - Phone:866-491-5807
Mailing Address - Fax:913-491-0411
Practice Address - Street 1:7500 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-398-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE116372085R0202X
IA206082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1600519OtherUHC SHARE ALLIANCE
IA19314OtherBCBS
IA6793321Medicaid
IA7973321Medicaid
1600005OtherUHC SHARE ALLIANCE
NE00701OtherBCBS
IA2973321Medicaid
IA5973321Medicaid
10861OtherMIDLANDS
IA8973321Medicaid
IABS6851667OtherIA CONTROLLED SUBSTANCE
IABS6851667OtherIA CONTROLLED SUBSTANCE
NE300032934Medicare PIN
NE088362Medicare PIN
AS3998854OtherDEA
B90862Medicare UPIN
NENA1356009Medicare PIN
NE00701OtherBCBS
NENA1355009Medicare PIN