Provider Demographics
NPI:1124228374
Name:STERN, ERIC JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JACOB
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR ROAD, NW
Practice Address - Street 2:GEORGETOWN UNIVERSITY HOSPITAL, 2-PHC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-8262
Practice Address - Fax:202-444-7161
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0379922080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124228374Medicaid
DC0523722400Medicaid
VA1124228374Medicaid