Basic Information
Provider Information
NPI: 1831197045
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STOLL
FirstName: SCOTT
MiddleName: RONALD
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Practice Location
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Other Information
ProviderEnumerationDate: 07/12/2005
LastUpdateDate: 05/29/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XMD419657PAY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

ID Information
IDTypeStateIssuerDescription
001903454000305PA MEDICAID
020874600001 INDEPENDENCE BLUE CROSSOTHER
217056501 MAMSIOTHER
5001184501 CAPITAL BLUE CROSSOTHER
328690401 HEALTH AMERICA/HEALTH ASSOTHER
7592801 GEISINGER HEALTH PLANOTHER
26005106301 RAILROAD MEDICAREOTHER
300126501 AETNA PPOOTHER
020874600001 AMERIHEALTHOTHER
139862601 HIGHMARK BLUE SHIELDOTHER
5001184501 KEYSTONE HEALTH CENTRALOTHER
924433701 PRIVATE HEALTHCARE SYSTEMOTHER
P315965501 OXFORD HEALTH PLANSOTHER
82113701 FIRST PRIORITY HEALTHOTHER
020874600001 KEYSTONE HEALTH EASTOTHER
215010901 UNITED HEALTHCAREOTHER


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