Provider Demographics
NPI:1356324495
Name:STOLLER, HERSCHEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:E
Last Name:STOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 NICHOLAS ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2184
Mailing Address - Country:US
Mailing Address - Phone:402-398-9200
Mailing Address - Fax:402-398-9400
Practice Address - Street 1:10110 NICHOLAS ST
Practice Address - Street 2:SUITE #103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2184
Practice Address - Country:US
Practice Address - Phone:402-398-9200
Practice Address - Fax:402-398-9400
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE13516207N00000X, 207ZD0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064032502Medicaid
NE095082Medicare ID - Type Unspecified
NEB67761Medicare UPIN