MEDICARE: BRUCE I STARK MD

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	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	MD022743E	PA
2	207W00000X	Ophthalmology Physician	MD022743E	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1689674921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE I STARK MD

Provider Business Mailing Address
First Line	:	915 OLD FERN HILL RD
Second Line	:	BUILDING B SUITE 200
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4269
Country	:	US
Telephone Number	:	610-696-1230
Fax Number	:	610-918-0803

Provider Business Practice Location Address
First Line	:	915 OLD FERN HILL RD
Second Line	:	BUILDING B SUITE 200
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-4269
Country	:	US
Telephone Number	:	610-696-1230
Fax Number	:	610-918-0803

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	05/02/2019

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Directions to “ BRUCE I STARK MD” Practice Location

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