Healthcare Provider Details

I. General information

NPI: 1922387992
Provider Name (Legal Business Name): TERRENCE STONE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 RIXTOWN CT
CHESAPEAKE VA
23322-9094
US

IV. Provider business mailing address

2800 GODWIN BLVD STE 210
SUFFOLK VA
23434-8038
US

V. Phone/Fax

Practice location:
  • Phone: 757-546-0388
  • Fax:
Mailing address:
  • Phone: 757-934-4162
  • Fax: 757-934-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-001750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: