1437151388 NPI number — LARRY A STERN MD

Table of content: LARRY A STERN MD (NPI 1437151388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437151388 NPI number — LARRY A STERN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
LARRY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1437151388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3540 BURBANK RD # 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOOSTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44691-8539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-465-4429
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1761 BEALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOOSTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44691-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-263-8759
Provider Business Practice Location Address Fax Number:
330-263-8752
Provider Enumeration Date:
08/11/2005

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: 208600000X , with the licence number:  35054753S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 35054753S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0167055 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020052952 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000222078 . This is a "ANTHEM BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020556806LS . This is a "SUMMACARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: L0167055 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020556806 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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