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General NPI Number Information
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NPI Number | 1356867618
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Entity Type | Organization
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Legal Business Name | STAR ADVANCED MEDICINE LLC
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2325 HERITAGE CENTER DR STE 215
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City | FURLONG
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State | PA
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Zip | 18925-1262
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Country | US
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Telephone | 267-544-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 HERITAGE CENTER DR STE 215
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City | FURLONG
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State | PA
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Zip | 18925-1262
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Country | US
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Telephone | 267-544-0664
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BONNIE MCKINLEY
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Credential | DO
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Telephone | 267-544-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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