Provider Demographics
NPI:1154486421
Name:STONESTOWN PEDIATRICS
Entity Type:Organization
Organization Name:STONESTOWN PEDIATRICS
Other - Org Name:STONESTOWN PEDIATRIC MEDICAL OFFICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOLLOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-566-2727
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:#355
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-566-2727
Mailing Address - Fax:415-566-0081
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:#355
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-566-2727
Practice Address - Fax:415-566-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27394207KA0200X
CAFNP30374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY20778YMedicaid