Provider Demographics
NPI:1174727960
Name:STERN, JOSHUA MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
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 1:3 WOODLAND RD STE 216
Mailing Address - Street 2:MYSTIC VALLEY UROLOGY
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1711
Mailing Address - Country:US
Mailing Address - Phone:781-979-0661
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD STE 216
Practice Address - Street 2:MYSTIC VALLEY UROLOGY
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1711
Practice Address - Country:US
Practice Address - Phone:781-979-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085605AMedicaid
MAP00940628OtherMEDICARE RR
MAJ46331OtherBCBS
MAJ46331OtherBCBS