1235193236 NPI number — DR. STEPHEN F STERN D.P.M.

Table of content: DR. STEPHEN F STERN D.P.M. (NPI 1235193236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235193236 NPI number — DR. STEPHEN F STERN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
STEPHEN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1235193236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 MAPLE AVE E
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22180-4746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-281-4500
Provider Business Mailing Address Fax Number:
703-242-8475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 MAPLE AVE E
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22180-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-281-4500
Provider Business Practice Location Address Fax Number:
703-242-8475
Provider Enumeration Date:
04/14/2006

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: 213ES0103X , with the licence number:  0103000238 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 312945 . This is a "MDIPA/OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4092107 . This is a "AETNA MC" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 7246 . This is a "BLUE SHIELD OF DC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0587601 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 061712 . This is a "BLUE SHIELD OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 27-00089 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 930043-1 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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