Provider Demographics
NPI:1720095144
Name:STONE, BRYAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8900
Mailing Address - Fax:978-557-8944
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8900
Practice Address - Fax:978-557-8944
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8600207K00000X
MA60030207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA060030OtherTUFTS
MAAA100709OtherHARVARD PILGRIM HEALTH CARE
MA0043949OtherNEIGHBORHOOD HEALTH PLAN
NHE82846OtherANTHEM BS
MA1720095144OtherFALLON COMMUNITY HEALTH PLAN
MAJ1097301OtherMEDICARE PTAN
MA1720095144OtherAETNA HMO
NH30204073Medicaid
MA4259414OtherAETNA NON HMO
MA980197-02OtherNETWORK HEALTH PLAN
MAP00693203OtherRAILROAD MEDICARE
MA0153496OtherCIGNA
MA110003929AOtherMASSHEALTH
MAJ10973OtherBCBS
MAJ10973OtherHMO BLUE
MA02-02017OtherEVERCARE
NH30204073Medicaid