Provider Demographics
NPI:1871593848
Name:STERN, CHARLES A (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
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:HEALTH FIRST PHYSICIANS INC
Mailing Address - Street 2:PO BOX 561600
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956
Mailing Address - Country:US
Mailing Address - Phone:321-434-7313
Mailing Address - Fax:321-434-7238
Practice Address - Street 1:1350 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3278
Practice Address - Country:US
Practice Address - Phone:321-434-7313
Practice Address - Fax:321-434-7238
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAME 134452085R0202X
FLME134452085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268483700Medicaid
D62081Medicare UPIN
FL29569WMedicare ID - Type Unspecified