1144453879 NPI number — ANDREA N STONE PT

Table of content: ANDREA N STONE PT (NPI 1144453879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144453879 NPI number — ANDREA N STONE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
ANDREA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144453879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 WESTERN MARYLAND PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HAGERSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21740-5471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-797-6389
Provider Business Mailing Address Fax Number:
301-797-4119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WESTERN MARYLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-797-6389
Provider Business Practice Location Address Fax Number:
301-797-4119
Provider Enumeration Date:
08/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  22984 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00854250 . This is a "RR MEDICARE MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 95627601 . This is a "BCBS LOCAL CAREFIRST KG85" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 418531500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W2660023 . This is a "BCBS REGIONAL CAREFIRST W266" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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