Provider Demographics
NPI:1972789519
Name:STONE, JODIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:A
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:A
Other - Last Name:UGAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 26135
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2012
Mailing Address - Country:US
Mailing Address - Phone:301-588-7888
Mailing Address - Fax:301-587-5002
Practice Address - Street 1:7811 MONTROSE RD STE 220
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3353
Practice Address - Country:US
Practice Address - Phone:301-588-7888
Practice Address - Fax:301-587-5002
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant