MEDICARE: BRIDGE STONE CONSULTANTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	252Y00000X	Early Intervention Provider Agency
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center
5	261QP0905X	State or Local Public Health Clinic/Center
6	261QR1100X	Research Clinic/Center
7	261QS1000X	Student Health Clinic/Center
8	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
9	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1902381031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE STONE CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	10535 EDGEMONT DR
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1114
Country	:	US
Telephone Number	:	518-269-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	10535 EDGEMONT DR
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1114
Country	:	US
Telephone Number	:	518-269-2455
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JAMES E MCDOWELL JR.
Credential	:
Telephone Number	:	518-269-2455

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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