Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | OS009472L | PA |
Y | 207Q00000X | Family Doctor | OS009472L | PA |
N | 208D00000X | General Practice Physician | OS009472L | PA |
NPI | 1023065968 |
---|---|
Provider Name | Douglas D Stern |
First Address | Mc Connellsburg, PA 17233-8559 |
Second Address | Mc Connellsburg, PA 17233-8559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101872664 | (05) | PA |
G65657 | (02) |