Healthcare Provider Details

I. General information

NPI: 1598952160
Provider Name (Legal Business Name): JAY IVAN STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 03/07/2023
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5804 BALTIMORE AVENUE
HYATTSVILLE MD
20781
US

IV. Provider business mailing address

5501 45TH AVENUE APT. #501
HYATTSVILLE MD
20781
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-7800
  • Fax: 301-927-0375
Mailing address:
  • Phone: 410-608-1618
  • Fax: 561-766-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0034206
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: