Healthcare Provider Details

I. General information

NPI: 1538572417
Provider Name (Legal Business Name): JEREMY GUY STONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ST STE 401
ERIE PA
16507-1438
US

IV. Provider business mailing address

300 STATE ST STE 401
ERIE PA
16507-1438
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5330
  • Fax: 814-877-5331
Mailing address:
  • Phone: 814-877-5330
  • Fax: 814-877-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberMD473175
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD473175
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: