Provider Demographics
NPI:1912086208
Name:STOLL, ANDREW MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
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:POB 1277
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1277
Mailing Address - Country:US
Mailing Address - Phone:802-229-1950
Mailing Address - Fax:802-888-6659
Practice Address - Street 1:3 PITKIN CT
Practice Address - Street 2:SUITE 201W
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-4509
Practice Address - Country:US
Practice Address - Phone:802-229-1950
Practice Address - Fax:802-888-6659
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT4287012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0638Medicaid
OVN0638Medicare ID - Type Unspecified
VTOVN0638Medicaid