Provider Demographics
NPI:1528063872
Name:STERN, JEREMY BEN (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:BEN
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300C FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1257
Mailing Address - Country:US
Mailing Address - Phone:508-998-6100
Mailing Address - Fax:508-998-1411
Practice Address - Street 1:300C FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1257
Practice Address - Country:US
Practice Address - Phone:508-998-6100
Practice Address - Fax:508-998-1411
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76678207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9778837Medicaid
MA3101681Medicaid
MA200023245OtherRAILROAD MEDICARE
MA3101681Medicaid
MA1121120001Medicare NSC
MAE95226Medicare UPIN
MAM20204Medicare PIN