Provider Demographics
NPI:1316135593
Name:MCCUBBIN, ADRIANA STONE (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:STONE
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:STONE
Other - Last Name:GOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-2349
Mailing Address - Fax:502-588-9535
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 802
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3904
Practice Address - Country:US
Practice Address - Phone:502-588-2349
Practice Address - Fax:502-588-9535
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41211208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201010970Medicaid
KY7100026690Medicaid
KY0225913Medicare PIN
IN201010970Medicaid