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NPI Code Detail

MEDICARE: BRIAN JOSEPH STARK DO

MEDICARE: BRIAN JOSEPH STARK DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS009405LPA

General Provider Information

NPI Number : 1497755292
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN JOSEPH STARK DO
Provider Business Mailing Address
First Line : 7287 W RIDGE RD
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415-1130
Country : US
Telephone Number : 814-877-2360
Fax Number : 814-474-3561
Provider Business Practice Location Address
First Line : 7287 W RIDGE RD
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415-1130
Country : US
Telephone Number : 814-877-2360
Fax Number : 814-474-3561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 04/21/2020

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Directions to “ BRIAN JOSEPH STARK DO” Practice Location

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