Provider Demographics
NPI:1932166063
Name:STOLLINGS, RONNY D (MD)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:D
Last Name:STOLLINGS
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 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-369-5170
Mailing Address - Fax:304-369-0946
Practice Address - Street 1:471 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1223
Practice Address - Country:US
Practice Address - Phone:304-369-5170
Practice Address - Fax:304-369-0946
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV987460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000479000Medicaid
WVA72383Medicare UPIN
WV0574311Medicare ID - Type Unspecified