Provider Demographics
NPI:1790845675
Name:STONEVIEW INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:STONEVIEW INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLACKSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-963-8002
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:727 E MAIN STREET SUITE 300
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-0279
Mailing Address - Country:US
Mailing Address - Phone:864-963-8002
Mailing Address - Fax:864-963-2742
Practice Address - Street 1:727 E MAIN STREET SUITE 300
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-0279
Practice Address - Country:US
Practice Address - Phone:864-963-8002
Practice Address - Fax:864-963-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18747207R00000X
SC15537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497766588OtherNPI
1366453458OtherNPI
SC6P28H2Medicaid
SC6P28H2Medicaid
1497766588OtherNPI
G65412Medicare UPIN