Provider Demographics
NPI:1154396679
Name:STONE, PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
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:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:MD
Mailing Address - Zip Code:21765-0418
Mailing Address - Country:US
Mailing Address - Phone:410-442-6864
Mailing Address - Fax:
Practice Address - Street 1:16013 FIELDS END CT
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-7542
Practice Address - Country:US
Practice Address - Phone:410-442-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD373091300Medicaid
MD008203100Medicaid
MD0403181OtherEVERCARE
093NER-534556-02OtherCAREFIRST BCBS OF MD
T016-0007OtherBCBS-DC
MD53455602OtherBCBS
KGO1ER-534556-02OtherCAREFIRST BCBS OF MD
MDF99304Medicare UPIN
MD990CMedicare PIN
093NER-534556-02OtherCAREFIRST BCBS OF MD