Provider Demographics
NPI:1114927431
Name:STOLL, DAVID B
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:STOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4432
Mailing Address - Country:US
Mailing Address - Phone:401-766-9500
Mailing Address - Fax:401-766-7464
Practice Address - Street 1:55 HAMLET AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4432
Practice Address - Country:US
Practice Address - Phone:401-766-9500
Practice Address - Fax:401-766-7464
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6416207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000444Medicaid
0478325OtherAETNA
93566221OtherCIGNA
22430OtherBLUE CROSS OF RI
725043OtherTUFTS HEALTH PLAN
002191OtherBLUE CHIP
1082OtherNEIGHBORHOOD HEALTH PLAN OF RI
0478325OtherAETNA
C90520Medicare UPIN