Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | OS006048E | PA |
NPI | 1538239603 |
---|---|
Provider Name | Dr. Roy B Stoller |
First Address | Wallingford, PA 19086-6337 |
Second Address | Chadds Ford, PA 19317-9784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |