Provider Demographics
NPI:1912231408
Name:SCOTT T STOLL DO PHD PA
Entity Type:Organization
Organization Name:SCOTT T STOLL DO PHD PA
Other - Org Name:STOLL NEURODIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:STOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-294-3195
Mailing Address - Street 1:5717 EDWARDS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4116
Mailing Address - Country:US
Mailing Address - Phone:817-294-3195
Mailing Address - Fax:817-294-3466
Practice Address - Street 1:5717 EDWARDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4116
Practice Address - Country:US
Practice Address - Phone:817-294-3195
Practice Address - Fax:817-294-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9575208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027TAOtherBCBS
TX211320101Medicaid
TX0A6054Medicare PIN
TX211320101Medicaid