Provider Demographics
NPI:1770840167
Name:STOLL, SIDNEY MORRIS (DO)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:MORRIS
Last Name:STOLL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-254-0046
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4680
Practice Address - Country:US
Practice Address - Phone:323-489-6010
Practice Address - Fax:833-402-0866
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A16313207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A16313OtherMEDICAL