Provider Demographics
NPI:1831157593
Name:STOLL, BRIAN D (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
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 1:315 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1703
Mailing Address - Country:US
Mailing Address - Phone:502-629-2500
Mailing Address - Fax:502-629-3166
Practice Address - Street 1:4001 DUTCHMANS LN
Practice Address - Street 2:SUITE G02
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4714
Practice Address - Country:US
Practice Address - Phone:502-899-6601
Practice Address - Fax:502-899-6644
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200071510Medicaid
KY2556442OtherCIGNA PROVIDER NUMB
KY920005752OtherRAILROAD MEDICARE
KY5045158OtherAETNA PROVIDER NUMB
KY64262587Medicaid
KY000000111402OtherANTHEM PROVIDER NUMB
KY000020583IOtherHUMANA PROVIDER NUMB
KY1118182OtherPASSPORT PROVIDER NUMB
KY000020583IOtherHUMANA PROVIDER NUMB
KY0299011Medicare PIN