Provider Demographics
NPI:1619904190
Name:STERN, MELVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:J
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 1:12073 TECH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7873
Mailing Address - Country:US
Mailing Address - Phone:301-593-1315
Mailing Address - Fax:310-681-4699
Practice Address - Street 1:12073 TECH RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7873
Practice Address - Country:US
Practice Address - Phone:301-593-1315
Practice Address - Fax:310-681-4699
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00037822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD787591600Medicaid
DC00B696P32Medicare ID - Type Unspecified
MD787591600Medicaid
MD632MG973Medicare ID - Type Unspecified