Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 042.0012522 | VT |
N | 208800000X | Urologist | 256472-1 | NY |
NPI | 1003078932 |
---|---|
Provider Name | Mr. Kevan M Sternberg |
First Address | Burlington, VT 05401-1473 |
Second Address | Burlington, VT 05401-1473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2008 |
Last Update Date | 12/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
031395C8 | (05) | NY |
1021019 | (05) | VT |