MEDICARE: PAMELA ANN CUSHENBERRY STARKS 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	207Q00000X	Family Medicine Physician	A62497	CA

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

General Provider Information

NPI Number	:	1801844105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANN CUSHENBERRY STARKS M.D.

Provider Business Mailing Address
First Line	:	600 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-4201
Country	:	US
Telephone Number	:	209-521-6097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 DALE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-0500
Country	:	US
Telephone Number	:	209-522-0146
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/13/2017

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