Provider Demographics
NPI:1093749921
Name:STONE, EMILY (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4525 CAMERON VALLEY PKWY
Practice Address - Street 2:STE 1500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4369
Practice Address - Country:US
Practice Address - Phone:704-512-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093749921Medicaid
NC8101397Medicaid
SC0908PAMedicaid
NCQ17144Medicare UPIN
NC2760533UMedicare PIN
NCNC3316BMedicare PIN
NC2760533EMedicare PIN
NC2760533JMedicare PIN
NC2760533GMedicare PIN
SC0908PAMedicaid
NC1093749921Medicaid
NC2760533IMedicare PIN
NC2760533RMedicare PIN
NC2760533TMedicare PIN
NC2760533JMedicare UPIN
NC2760533PMedicare PIN
NCNC3316AMedicare PIN
NC2760533LMedicare PIN
NC2760533MMedicare PIN
NC2760533NMedicare PIN
NC2759080Medicare PIN
NC2760533FMedicare PIN
NC2760533KMedicare PIN