STOLLER, DAVID W (MD)

Provider Demographics

• NPI: 1255318036
• Name: STOLLER, DAVID W (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: DAVID
• Middle Name: W
• Last Name: STOLLER
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: PO BOX 6102
• Mailing Address - City: NOVATO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 94948-6102
• Mailing Address - Country: US
• Mailing Address - Phone: 415-884-3418
• Mailing Address - Fax: 415-883-8082
• Practice Address - Street 1: 3700 CALIFORNIA ST
• Practice Address - Street 2: SUITE G350
• Practice Address - City: SAN FRANCISCO
• Practice Address - State: CA
• Practice Address - Zip Code: 94118-1618
• Practice Address - Country: US
• Practice Address - Phone: 415-600-2940
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-22
• Last Update Date: 2010-06-01

Provider Licenses

State	License ID	Taxonomies
CA	G50834	2085R0202X
AK	5855	2085R0202X
AZ	35464	2085R0202X
CO	30786	2085R0202X
NJ	25MA07189700	2085R0202X
IL	036.103835	207K00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology
No	207K00000X	Allopathic & Osteopathic Physicians	Allergy & Immunology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	0144894	Other	L&I
NV	1255318036	Medicaid
WA	8169690	Medicaid
WA	300123273	Other	RAILROAD MEDICARE
AZ	111845	Medicaid
OK	200097670A	Medicaid
NJ	8940207	Medicaid
CA	300121756	Other	RAILROAD MEDICARE
WA	8933500	Other	L&I, CVCP
CO	93723288	Medicaid
CA	G00508340	Medicaid
WA	AB007760	Medicare PIN
CA	00G508348	Medicare PIN
CA	G00508340	Medicaid
NE	09984004	Medicare PIN
CA	00G5083415	Medicare PIN
CA	CE959U	Medicare PIN
CA	CE959W	Medicare PIN
CA	CE959P	Medicare UPIN
WA	8169690	Medicaid
CA	00G5083421	Medicare PIN
CA	CE959V	Medicare PIN
CA	CE959X	Medicare PIN
CA	00G508343	Medicare PIN
CA	00G5083420	Medicare PIN
CA	300121756	Other	RAILROAD MEDICARE
AZ	111845	Medicaid
CA	00G5083411	Medicare PIN
CA	00G5083424	Medicare PIN
CA	00G5083422	Medicare PIN
CA	00G508349	Medicare PIN
NV	V102062	Medicare PIN
NV	V105270	Medicare PIN
CA	CE959T	Medicare PIN
CO	CO300364	Medicare PIN
NJ	E54828	Medicare UPIN
CO	93723288	Medicaid
OK	200097670A	Medicaid
CA	00G5083414	Medicare PIN
CA	CE959O	Medicare PIN
OK	00G508341	Medicare PIN
CA	00G508344	Medicare PIN
CA	00G5083425	Medicare PIN