Provider Demographics
NPI:1235186008
Name:STOLL, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:STOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 MOWRY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1622
Mailing Address - Country:US
Mailing Address - Phone:501-248-1585
Mailing Address - Fax:510-739-1050
Practice Address - Street 1:2287 MOWRY AVE STE F
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1622
Practice Address - Country:US
Practice Address - Phone:510-248-1585
Practice Address - Fax:510-739-1050
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC156887207Q00000X, 207Q00000X
MEMD17374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1235186008Medicaid
NH3074637Medicaid
NH3074637Medicaid
NH000135301Medicare PIN