Provider Demographics
NPI:1184698672
Name:STONE, KIMBERLY JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JORDAN
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13609 CARROLLTON BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3214
Mailing Address - Country:US
Mailing Address - Phone:757-238-8751
Mailing Address - Fax:757-238-8750
Practice Address - Street 1:13609 CARROLLTON BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3214
Practice Address - Country:US
Practice Address - Phone:757-238-8751
Practice Address - Fax:757-238-8750
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022883207Q00000X
VA0101240770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015401M13Medicare PIN
VAP00463880Medicare PIN
VA013127M55Medicare PIN
VAI71992Medicare UPIN
VA015322M49Medicare PIN