Provider Demographics
NPI:1023021649
Name:STARCK-MCLEAN, LINDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:STARCK-MCLEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6692 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9602
Mailing Address - Country:US
Mailing Address - Phone:315-483-3205
Mailing Address - Fax:315-483-3232
Practice Address - Street 1:6692 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9602
Practice Address - Country:US
Practice Address - Phone:315-483-3205
Practice Address - Fax:315-483-3232
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01413941Medicaid
NYF57344Medicare UPIN
NY01413941Medicaid