Provider Demographics
NPI:1780772541
Name:STONE, JENNY L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MOCKSVILLE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3360
Mailing Address - Country:US
Mailing Address - Phone:704-636-0971
Mailing Address - Fax:704-636-0769
Practice Address - Street 1:203 MOCKSVILLE AVE STE B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3360
Practice Address - Country:US
Practice Address - Phone:704-636-0971
Practice Address - Fax:704-636-0769
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01741207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2074564Medicare PIN