MEDICARE: DR. STUART R STARK M.D.

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
1	2084N0400X	Neurology Physician	0101035202	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	884143	OTHER	VA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508836578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART R STARK M.D.

Provider Business Mailing Address
First Line	:	6845 ELM ST STE 514
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-266-6500
Fax Number	:	703-229-0367

Provider Business Practice Location Address
First Line	:	6845 ELM ST STE 514
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3822
Country	:	US
Telephone Number	:	703-266-6500
Fax Number	:	703-229-0367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/06/2018

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Directions to “ DR. STUART R STARK M.D.” Practice Location

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