Healthcare Provider Details

I. General information

NPI: 1417957879
Provider Name (Legal Business Name): KELLY D. STONE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW 111 MICHIGAN AVENUE, NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

2932 FAULKNER PL
KENSINGTON MD
20895-2310
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-4013
  • Fax:
Mailing address:
  • Phone: 301-933-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD31795
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberD0061853
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101236683
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: