Provider Demographics
NPI:1023052438
Name:STOLL, PHILIP MARTIN (DO, DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARTIN
Last Name:STOLL
Suffix:
Gender:M
Credentials:DO, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 STEPHANIE BOYD DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4423
Mailing Address - Country:US
Mailing Address - Phone:757-620-5158
Mailing Address - Fax:757-465-3527
Practice Address - Street 1:830 SOUTHAMPTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1001
Practice Address - Country:US
Practice Address - Phone:757-683-8366
Practice Address - Fax:757-683-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050003207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology