Provider Demographics
NPI:1609848365
Name:STOLL, HOWARD L (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:L
Last Name:STOLL
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:PO BOX 64715
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4715
Mailing Address - Country:US
Mailing Address - Phone:317-805-2311
Mailing Address - Fax:317-705-5060
Practice Address - Street 1:845 MAIN RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9706
Practice Address - Country:US
Practice Address - Phone:716-934-9001
Practice Address - Fax:716-934-9005
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203216-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000524423013OtherBCBS WESTERN NY
NY0156887OtherGHI
NY00025860708OtherUNIVERA
NY01800926Medicaid
NY070621000063OtherFIDELIS
NY1609208OtherINDEPENDENT HEALTH
NYRB4209Medicare PIN
NY070621000063OtherFIDELIS