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NPI Code Detail

MEDICARE: MARY JEAN STARK PAC

MEDICARE: MARY JEAN STARK PAC
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
1363A00000XPhysician AssistantMA003135LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00791043OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103246701OTHERPACAPITAL BLUE CROSS

General Provider Information

NPI Number : 1851352884
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JEAN STARK PAC
Provider Business Mailing Address
First Line : 601 MEMORY LN
Second Line :
City : YORK
State : PA
Zip : 17402-2231
Country : US
Telephone Number : 717-851-1405
Fax Number : 717-851-6969
Provider Business Practice Location Address
First Line : 9 NATHAN LN
Second Line :
City : ANNVILLE
State : PA
Zip : 17003-6500
Country : US
Telephone Number : 717-639-3350
Fax Number : 717-303-3546
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 03/06/2025

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Directions to “ MARY JEAN STARK PAC” Practice Location

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