MEDICARE: DR. ANDREA ZATLIN STARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34951	AZ
2	207L00000X	Anesthesiology Physician	A120203	CA

General Provider Information

NPI Number	:	1992778757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA ZATLIN STARK M.D.

Provider Business Mailing Address
First Line	:	1182 RIVER ROCK LN
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4004
Country	:	US
Telephone Number	:	480-272-1060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1182 RIVER ROCK LN
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4004
Country	:	US
Telephone Number	:	480-272-1060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	02/25/2012

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