Provider Demographics
NPI:1164043717
Name:STOLL, PETER KENNETH
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KENNETH
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 1:710 RESERVE CHAMPION DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5716
Mailing Address - Country:US
Mailing Address - Phone:646-373-7129
Mailing Address - Fax:
Practice Address - Street 1:10810 DARNESTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2604
Practice Address - Country:US
Practice Address - Phone:240-200-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist