Provider Demographics
NPI:1770609471
Name:STONE, RICHARD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
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 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-396-9941
Mailing Address - Fax:626-396-9586
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 407
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-396-9941
Practice Address - Fax:626-396-9586
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG299322086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91246Medicare UPIN