Individual
MRS. DIANE K STOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
144 STATE STREET, MERCY HOSPITAL, PORTLAND, ME 04101-3795
(207) 553-6808
Mailing address
144 STATE STREET, MERCY HOSPITAL, PORTLAND, ME 04101-3795
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
30027
MN
282NC0060X
Critical Access Hospital
MD21011
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04Q32ST
BLUE CROSS BLUE SHIELD
MN
05
—
154585000
—
MN
Enumeration date
11/01/2006
Last updated
12/14/2016
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