Provider Demographics
NPI:1144414178
Name:STOLL, MARCUS A (LMP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:A
Last Name:STOLL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W MAIN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:253-307-3913
Mailing Address - Fax:253-604-4450
Practice Address - Street 1:105 W MAIN
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:253-307-3913
Practice Address - Fax:253-604-4450
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist