Healthcare Provider Details

I. General information

NPI: 1205921855
Provider Name (Legal Business Name): MARC JASON STARER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

IV. Provider business mailing address

444 MONTGOMERY ST
CHICOPEE MA
01020-1969
US

V. Phone/Fax

Practice location:
  • Phone: 413-594-3111
  • Fax: 413-598-7115
Mailing address:
  • Phone: 413-594-3111
  • Fax: 413-598-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number242105
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: