Provider Demographics
NPI:1134264385
Name:STONE, JOHN DAVID (IDC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:STONE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COTILLION CRES
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8148
Mailing Address - Country:US
Mailing Address - Phone:843-486-3702
Mailing Address - Fax:
Practice Address - Street 1:3600 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7747
Practice Address - Country:US
Practice Address - Phone:843-574-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care