Provider Demographics
NPI:1194207225
Name:STONE, MATTHEW (LIC AC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHURCH ST STE 2J
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4462
Mailing Address - Country:US
Mailing Address - Phone:802-657-3700
Mailing Address - Fax:802-651-0756
Practice Address - Street 1:2 CHURCH ST STE 2J
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4462
Practice Address - Country:US
Practice Address - Phone:802-657-3700
Practice Address - Fax:802-651-0756
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0133895171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist