Healthcare Provider Details

I. General information

NPI: 1356867618
Provider Name (Legal Business Name): STAR ADVANCED MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 HERITAGE CENTER DR STE 215
FURLONG PA
18925-1262
US

IV. Provider business mailing address

2325 HERITAGE CENTER DR STE 215
FURLONG PA
18925-1262
US

V. Phone/Fax

Practice location:
  • Phone: 267-544-0664
  • Fax:
Mailing address:
  • Phone: 267-544-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE MCKINLEY
Title or Position: CEO
Credential: DO
Phone: 267-544-0664