Provider Demographics
NPI:1063486868
Name:STARR, MATTHEW D (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:STARR
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:316 1ST AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2264
Mailing Address - Country:US
Mailing Address - Phone:724-545-2205
Mailing Address - Fax:724-545-2600
Practice Address - Street 1:316 1ST AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2264
Practice Address - Country:US
Practice Address - Phone:724-545-2205
Practice Address - Fax:724-545-2600
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006496B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q10554Medicare UPIN
PA077213QUBMedicare ID - Type Unspecified