Provider Demographics
NPI:1629051156
Name:STIERNBERG, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:STIERNBERG
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:PO BOX 201157
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1157
Mailing Address - Country:US
Mailing Address - Phone:281-649-7310
Mailing Address - Fax:713-484-6649
Practice Address - Street 1:7789 SOUTHWEST FWY
Practice Address - Street 2:#470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1829
Practice Address - Country:US
Practice Address - Phone:281-649-7000
Practice Address - Fax:713-995-4720
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2046207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137650112Medicaid
TXB26697Medicare UPIN
TX00C310Medicare ID - Type Unspecified