Provider Demographics
NPI:1154436756
Name:STERN, CAROLYN RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:RUTH
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:STERN
Other - Last Name:SPANJER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:58 EASTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1030
Mailing Address - Country:US
Mailing Address - Phone:585-271-7004
Mailing Address - Fax:585-271-3826
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:WALK IN CARE CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209791207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4202OtherMEDICARE PROVIDER NUMBER
NYF65360Medicare UPIN
NYJ400000578-70008AGRPMedicare PIN
NYJ400000579-BA0017 GRMedicare PIN
NYP00695599-MRRMedicare PIN