Provider Demographics
NPI:1558379123
Name:STERN, SHAWN GLENN (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:GLENN
Last Name:STERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK
Mailing Address - Street 2:SUITE 702
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-8409
Mailing Address - Fax:304-243-8804
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:SUITE 702
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-8409
Practice Address - Fax:304-243-8804
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2214197Medicaid
WV1805687000Medicaid
110214253OtherRAILROAD MEDICARE
WVST7283261Medicare ID - Type Unspecified
H32351Medicare UPIN