Provider Demographics
NPI:1609805480
Name:STONY HILL INTERNAL MEDICINE INC
Entity type:Organization
Organization Name:STONY HILL INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-370-0295
Mailing Address - Street 1:11 SMOKEHOUSE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406
Mailing Address - Country:US
Mailing Address - Phone:540-370-0295
Mailing Address - Fax:540-370-0619
Practice Address - Street 1:11 SMOKEHOUSE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406
Practice Address - Country:US
Practice Address - Phone:540-370-0295
Practice Address - Fax:540-370-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010157404Medicaid
VAC09572Medicare PIN