Provider Demographics
NPI:1962468074
Name:STERNBERGER, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:STERNBERGER
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 1:821 HUNTINGDON PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8372
Mailing Address - Country:US
Mailing Address - Phone:215-576-0250
Mailing Address - Fax:215-576-8645
Practice Address - Street 1:821 HUNTINGDON PIKE STE 203
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8372
Practice Address - Country:US
Practice Address - Phone:215-576-0250
Practice Address - Fax:215-576-8645
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032424E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAST175311Medicare ID - Type Unspecified