Provider Demographics
NPI:1215922562
Name:STERN, JASON NOAH (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:NOAH
Last Name:STERN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 BRIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1133
Mailing Address - Country:US
Mailing Address - Phone:757-977-1026
Mailing Address - Fax:757-977-1027
Practice Address - Street 1:3907 BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1133
Practice Address - Country:US
Practice Address - Phone:757-977-1026
Practice Address - Fax:757-977-1027
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000889213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU42521Medicare UPIN
MIU42521Medicare UPIN