Healthcare Provider Details

I. General information

NPI: 1831631613
Provider Name (Legal Business Name): MATTHEW STARR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY ROAD
HAMILTON OH
45011-5307
US

IV. Provider business mailing address

9891 MONTGOMERY RD STE 340
CINCINNATI OH
45242-6424
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax: 513-672-0212
Mailing address:
  • Phone: 513-865-5204
  • Fax: 513-672-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: