Provider Demographics
NPI:1851762025
Name:STERN, EDWARD A (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:STERN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 EATON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2221
Mailing Address - Country:US
Mailing Address - Phone:571-463-8620
Mailing Address - Fax:571-999-7549
Practice Address - Street 1:1629 K ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1631
Practice Address - Country:US
Practice Address - Phone:571-463-8620
Practice Address - Fax:571-999-5749
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003989363LP0808X
VA0024182789363LP0808X
DCNP1008861363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health