=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821439852
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARA M. STONE D.P.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2013
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 192 TILLEY DR. UVM MEDICAL CENTER/ORTHOPEDICS, FOOT & ANKLE
-----------------------------------------------------
City | S. BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-847-4690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 TILLEY DR. UVM MEDICAL CENTER/ORTHOPEDICS, FOOT & ANKLE
-----------------------------------------------------
City | S. BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-847-4690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | LPR00124
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | CLPR00124
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 056.0000191
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------