Provider Demographics
NPI:1710928478
Name:STONE, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3811
Mailing Address - Country:US
Mailing Address - Phone:609-714-1014
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:BUILDING 900 SUITE 908-909
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5549
Practice Address - Country:US
Practice Address - Phone:609-407-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05398207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6349307Medicaid
NJ60018887OtherHORIZON NJ HEALTH
NJ0744844000OtherAMERIHEALTH
NJ30036756OtherKEYSTONE MERCY
F93757Medicare UPIN
NJ0744844000OtherAMERIHEALTH
NJ6349307Medicaid
NJ559960ZEDBMedicare PIN