Basic Information
Provider Information | |||||||||
NPI: | 1508887282 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STONER | ||||||||
FirstName: | DEBRA | ||||||||
MiddleName: | IRENE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 130 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | LEWISBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 178379315 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5705224110 | ||||||||
FaxNumber: | 5705224120 | ||||||||
Practice Location | |||||||||
Address1: | 1 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | LEWISBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 178379314 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5705224110 | ||||||||
FaxNumber: | 5705224120 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2006 | ||||||||
LastUpdateDate: | 11/02/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD048112L | PA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 105936 | 01 | PA | BLUE SHIELD | OTHER | 930045255 | 01 | PA | RAILROAD MEDICARE | OTHER | 105936 | 01 | PA | KEYSTONE | OTHER | 321845 | 01 | PA | HEALTH AMERICA | OTHER | 232809429 | 01 | PA | TRICARE | OTHER | 12997060010 | 05 | PA |   | MEDICAID |