Provider Demographics
NPI:1437151388
Name:STERN, LARRY A (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 BURBANK RD # 127
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8539
Mailing Address - Country:US
Mailing Address - Phone:330-465-4429
Mailing Address - Fax:
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-263-8759
Practice Address - Fax:330-263-8752
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054753S208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167055Medicaid
020052952OtherRAILROAD MEDICARE
000000222078OtherANTHEM BC/BS
020556806LSOtherSUMMACARE INC
OHL0167055Medicaid
OH020556806OtherWORKERS COMPENSATION
OHL0167055Medicaid
000000222078OtherANTHEM BC/BS