Provider Demographics
NPI:1356594352
Name:STOLZ, JONATHAN LAVERY (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LAVERY
Last Name:STOLZ
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 1:145 CAPTAINE GRAVES
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8906
Mailing Address - Country:US
Mailing Address - Phone:757-229-2498
Mailing Address - Fax:
Practice Address - Street 1:145 CAPTAINE GRAVES
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-8906
Practice Address - Country:US
Practice Address - Phone:757-229-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012329802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology