Provider Demographics
NPI:1871688531
Name:STERN, JEFFREY TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
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 1:51 DEPOT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2629
Mailing Address - Country:US
Mailing Address - Phone:860-274-2418
Mailing Address - Fax:860-274-2986
Practice Address - Street 1:51 DEPOT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2629
Practice Address - Country:US
Practice Address - Phone:860-274-2418
Practice Address - Fax:860-274-2986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010021487CT01OtherANTHEM BLUE CROSS
CT06-1009203OtherPROVIDER NUMBER
CT706203OtherCONNECTICARE
CTP1009203OtherOXFORD
CT06-1009203OtherUNITED HEALTHCARE
CT110000955Medicare ID - Type Unspecified
CT06-1009203OtherUNITED HEALTHCARE