MEDICARE: DR. KELLY D. STONE M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0201X	Pediatric Allergy/Immunology Physician	MD31795	DC
2	2080P0201X	Pediatric Allergy/Immunology Physician	D0061853	MD
3	2080P0201X	Pediatric Allergy/Immunology Physician	0101236683	VA

General Provider Information

NPI Number	:	1417957879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY D. STONE M.D., PH.D.

Provider Business Mailing Address
First Line	:	2932 FAULKNER PL
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2310
Country	:	US
Telephone Number	:	301-933-7460
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MICHIGAN AVE NW
Second Line	:	111 MICHIGAN AVENUE, NW
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2978
Country	:	US
Telephone Number	:	202-884-4013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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