Provider Demographics
NPI:1023632809
Name:STOLL, CAITLIN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:MARIE
Last Name:STOLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 ASHLEY CROSSING DR UNIT 536
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6168
Mailing Address - Country:US
Mailing Address - Phone:386-479-8265
Mailing Address - Fax:
Practice Address - Street 1:2244 ASHLEY CROSSING DR UNIT 536
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6168
Practice Address - Country:US
Practice Address - Phone:386-479-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics