Provider Demographics
NPI:1043319684
Name:STERN, ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4347
Mailing Address - Country:US
Mailing Address - Phone:252-247-3476
Mailing Address - Fax:704-675-7279
Practice Address - Street 1:3608 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4347
Practice Address - Country:US
Practice Address - Phone:252-247-3476
Practice Address - Fax:252-247-3478
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04814363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068FKOtherBCBSNC
NC7212085Medicaid
NC250141Medicare PIN
NC7212085Medicaid