Provider Demographics
NPI:1154443224
Name:STERN, SUSAN W (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BARTLETT TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2314
Mailing Address - Country:US
Mailing Address - Phone:617-413-7278
Mailing Address - Fax:
Practice Address - Street 1:64 LAFAYETTE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2456
Practice Address - Country:US
Practice Address - Phone:603-379-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151438207R00000X
NH14607207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine