Provider Demographics
NPI:1124210851
Name:JUDY STONE, MD, PA
Entity Type:Organization
Organization Name:JUDY STONE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-8088
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-777-8088
Mailing Address - Fax:301-777-8699
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:301-777-8088
Practice Address - Fax:301-777-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029574261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32275110Medicaid
MD32275110Medicaid