Healthcare Provider Details

I. General information

NPI: 1639134778
Provider Name (Legal Business Name): PHILIP JOSEPH STERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 COLUMBUS ST
GROVE CITY OH
43123
US

IV. Provider business mailing address

3055 COLUMBUS ST
GROVE CITY OH
43123
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-9900
  • Fax: 614-875-9900
Mailing address:
  • Phone: 614-875-9900
  • Fax: 614-875-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number350411145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: