MEDICARE: JOSHUA MICHAEL STERN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	239900	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00940628	OTHER	MA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J46331	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1174727960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA MICHAEL STERN MD

Provider Business Mailing Address
First Line	:	3 WOODLAND RD STE 216
Second Line	:	MYSTIC VALLEY UROLOGY
City	:	STONEHAM
State	:	MA
Zip	:	02180-1711
Country	:	US
Telephone Number	:	781-979-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WOODLAND RD STE 216
Second Line	:	MYSTIC VALLEY UROLOGY
City	:	STONEHAM
State	:	MA
Zip	:	02180-1711
Country	:	US
Telephone Number	:	781-979-0661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/16/2011

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