1962483107 NPI number — ROBERT CHARLES STERN MD

Table of content: ROBERT CHARLES STERN MD (NPI 1962483107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962483107 NPI number — ROBERT CHARLES STERN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
ROBERT
Provider Middle Name:
CHARLES
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:
1962483107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 164106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-901-1206
Provider Business Mailing Address Fax Number:
512-901-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SCENIC DR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626-7726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-943-3000
Provider Business Practice Location Address Fax Number:
512-942-4781
Provider Enumeration Date:
11/07/2005

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: 207ZP0102X , with the licence number:  G0166 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 027095 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 123771104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123771108 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123771106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123771105 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8Z0892 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com