Healthcare Provider Details

I. General information

NPI: 1144724139
Provider Name (Legal Business Name): ALICIA CLAIRE FIRESTONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

ONE MEDICAL CENTER BOULEVARD
WINSTON SALEM NC
27157-1084
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-3200
  • Fax: 336-890-3290
Mailing address:
  • Phone: 336-716-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-00632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: