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General NPI Number Information
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NPI Number | 1366573578
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Entity Type | Individual
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Provider Name | LINDA DIANE STARK PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9105 FRANKLIN SQUARE DR SUITE 100
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City | ROSEDALE
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State | MD
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Zip | 21237-3930
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Country | US
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Telephone | 443-777-8822
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Fax | 443-777-8823
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Provider Business Mailing Address
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Address Line | 3923 FEDERAL HILL RD
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City | JARRETTSVILLE
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State | MD
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Zip | 21084-1525
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Country | US
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Telephone | 410-557-6663
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001036
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License Number State | MD
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