Provider Demographics
NPI:1861436958
Name:STOLL, KANTHA RAJYASHREE (MD)
Entity type:Individual
Prefix:DR
First Name:KANTHA
Middle Name:RAJYASHREE
Last Name:STOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:100D
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2926
Mailing Address - Country:US
Mailing Address - Phone:703-212-4825
Mailing Address - Fax:703-212-4829
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:100D
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-212-4825
Practice Address - Fax:703-212-4829
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD10147191Medicaid
VAG02794A01Medicare PIN
VAP00290438Medicare PIN