Provider Demographics
NPI:1700825437
Name:STONE, VICKI L (DPM)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 LINCOLN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3646
Mailing Address - Country:US
Mailing Address - Phone:508-757-4003
Mailing Address - Fax:508-755-7592
Practice Address - Street 1:299 LINCOLN ST STE 202
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3646
Practice Address - Country:US
Practice Address - Phone:508-757-4003
Practice Address - Fax:508-755-7592
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006777213E00000X
MA2480213E00000X
MD01556213E00000X
ORDP00237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4232747 01Medicaid
MD385629ZSAPMedicare PIN
ORU32604Medicare UPIN
PA540318ZTHZMedicare PIN
MD385629YFCHMedicare PIN