1487688420 NPI number — CRAIG STERNBERG M.D.

Table of content: CRAIG STERNBERG M.D. (NPI 1487688420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487688420 NPI number — CRAIG STERNBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERNBERG
Provider First Name:
CRAIG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487688420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 GLASGOW AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-4773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-832-3369
Provider Business Mailing Address Fax Number:
302-832-5854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87B OMEGA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-733-0980
Provider Business Practice Location Address Fax Number:
302-733-7495
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081S0010X , with the licence number:  C10002806 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250002274 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "TRICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000131501 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 386606954 . This is a "BC/BS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 74783 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 122577 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 102053 . This is a "AMERIHEALTH-PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 293738 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4294011 . This is a "AETNA-PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "DEVON NETWORK" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P1220925 . This is a "OXFORD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000131501 . This is a "DE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0079419000 . This is a "AMERIHEALTH-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0017783 . This is a "AETNA-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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