Provider Demographics
NPI:1598746463
Name:VAN STOLK, ROSALIND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:
Last Name:VAN STOLK
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 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-229-5498
Practice Address - Street 1:1 LIBERTY SQ
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2636
Practice Address - Country:US
Practice Address - Phone:860-229-9688
Practice Address - Fax:860-229-5498
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042406207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001424069Medicaid
D400071172OtherID NUMBER
CTF09326Medicare UPIN
CT100000380Medicare PIN