Healthcare Provider Details

I. General information

NPI: 1659804896
Provider Name (Legal Business Name): JARLE ADAM STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

800 SPRUCE ST 1 PINE WEST
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-7817
  • Fax:
Mailing address:
  • Phone: 215-829-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60638
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD473827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: