Healthcare Provider Details

I. General information

NPI: 1497721229
Provider Name (Legal Business Name): ANDREA ELLEN STERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MERRIMACK ST SUITE 200
LOWELL MA
01852-1729
US

IV. Provider business mailing address

45 MERRIMACK ST SUITE 200
LOWELL MA
01852-1729
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-2306
  • Fax: 978-453-9394
Mailing address:
  • Phone: 978-459-2306
  • Fax: 978-453-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44252
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: