Healthcare Provider Details

I. General information

NPI: 1790732154
Provider Name (Legal Business Name): STEPHEN D STARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 W BOYLSTON ST SUITE 224
WEST BOYLSTON MA
01583-2373
US

IV. Provider business mailing address

354 W BOYLSTON ST SUITE 224
WEST BOYLSTON MA
01583-2373
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-0470
  • Fax: 508-756-0471
Mailing address:
  • Phone: 508-756-0470
  • Fax: 508-756-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number217763
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: