Provider Demographics
NPI:1679503676
Name:STERN, SUSAN AMY (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:AMY
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:UNIVERSITY OF WASHINGTON
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6123
Mailing Address - Country:US
Mailing Address - Phone:206-744-2121
Mailing Address - Fax:206-744-2123
Practice Address - Street 1:1959 NE PACIFIC ST.
Practice Address - Street 2:ROOM NN 256
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6123
Practice Address - Country:US
Practice Address - Phone:206-598-4000
Practice Address - Fax:206-598-4569
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60071165207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0249344OtherL&I
WA8881259Medicare PIN
E89383Medicare UPIN