Healthcare Provider Details

I. General information

NPI: 1790776417
Provider Name (Legal Business Name): LAWRENCE E STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LAWRENCE EDWARD STERN MD

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 PROPERSITY AVENUE 200
FAIRFAX VA
22031
US

IV. Provider business mailing address

2710 PROPERSITY AVENUE 200
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-2841
  • Fax: 703-280-4773
Mailing address:
  • Phone: 703-280-2841
  • Fax: 703-280-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101236110
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101236110
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: