Healthcare Provider Details

I. General information

NPI: 1073693412
Provider Name (Legal Business Name): ANN STARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # ROSE3
BOSTON MA
02215
US

IV. Provider business mailing address

3601 TVC
NASHVILLE TN
37232-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3276
  • Fax: 617-667-7040
Mailing address:
  • Phone: 615-322-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberL8964
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD47955
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: