Provider Demographics
NPI:1902829260
Name:STERN, ROHAN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:ANTHONY
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 1:110 KINGSLEY LN STE 305
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4617
Mailing Address - Country:US
Mailing Address - Phone:757-889-5422
Mailing Address - Fax:757-889-5450
Practice Address - Street 1:110 KINGSLEY LN STE 305
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4617
Practice Address - Country:US
Practice Address - Phone:757-889-5422
Practice Address - Fax:757-889-5450
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2226372085R0202X
VA01012611572085R0202X
NY2762972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902829260Medicaid