Healthcare Provider Details

I. General information

NPI: 1215922562
Provider Name (Legal Business Name): JASON NOAH STERN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 BRIDGE RD STE 101
SUFFOLK VA
23435-1133
US

IV. Provider business mailing address

3907 BRIDGE RD STE 101
SUFFOLK VA
23435-1133
US

V. Phone/Fax

Practice location:
  • Phone: 757-977-1026
  • Fax: 757-977-1027
Mailing address:
  • Phone: 757-977-1026
  • Fax: 757-977-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000889
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000889
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: