Provider Demographics
NPI:1588215032
Name:STONE RIDGE FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:STONE RIDGE FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRADNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRSOLKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-601-0174
Mailing Address - Street 1:42619 KELLAMUGH TER
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-6082
Mailing Address - Country:US
Mailing Address - Phone:315-601-1768
Mailing Address - Fax:
Practice Address - Street 1:24560 SOUTHPOINT DR STE 220
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3504
Practice Address - Country:US
Practice Address - Phone:315-601-0174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty