Individual
MORDECAI JEREMIAH STOLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
318 WATERMAN AVE, EAST PROVIDENCE, RI 02914-3525
(401) 438-5950
(401) 435-6700
Mailing address
318 WATERMAN AVE, EAST PROVIDENCE, RI 02914-3525
(401) 438-5950
(401) 435-6700
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
241535
MA
207RN0300X
Nephrology Physician
Primary
MD13046
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124225594
BLUE CROSS OF MASS
MA
01
—
1124225594
RI BLUE CROSS
RI
05
—
1124225594
—
RI
Enumeration date
06/29/2007
Last updated
10/29/2009
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