Provider Demographics
NPI:1245405240
Name:STERN, AUGUSTUS GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTUS
Middle Name:GRAHAM
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:220 CHAMPION DR
Mailing Address - Street 2:STE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6665
Mailing Address - Country:US
Mailing Address - Phone:301-791-0888
Mailing Address - Fax:301-791-3611
Practice Address - Street 1:220 CHAMPION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6558
Practice Address - Country:US
Practice Address - Phone:301-791-0888
Practice Address - Fax:301-791-3611
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200223207W00000X
TXN4128207W00000X
MDD74254207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD263393Medicare PIN
TX8L15733Medicare PIN
TXTXB118675Medicare PIN