Provider Demographics
NPI:1518921923
Name:STONE, PAMELA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 PITTSFORD VICTOR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9618
Mailing Address - Country:US
Mailing Address - Phone:585-276-7500
Mailing Address - Fax:585-218-0520
Practice Address - Street 1:1669 PITTSFORD VICTOR RD STE 100
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9618
Practice Address - Country:US
Practice Address - Phone:585-276-7500
Practice Address - Fax:585-218-0520
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177008208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01153644Medicaid
NYP080177008OtherBLUE SHIELD
NY5680177OtherAETNA
NYP010177008OtherEXCELLUS MANAGED CARE