=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316283542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD STOANE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2012
-----------------------------------------------------
Last Update Date | 12/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 KELSEY ST
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-5185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-347-7896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 KELSEY ST
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-5185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-347-7896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 013833
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------