Provider Demographics
NPI:1013907286
Name:STONE, BRIAN DOUGLASS (M D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DOUGLASS
Last Name:STONE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:2655 CAMINO DEL RIO N
Practice Address - Street 2:#120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1633
Practice Address - Country:US
Practice Address - Phone:619-286-6687
Practice Address - Fax:619-286-6695
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88917207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223775OtherMEDICARE PTAN
CACB223486OtherMEDICARE PTAN
NC898014YMedicaid
NC2154974AMedicare PIN