Provider Demographics
NPI:1083654479
Name:FIVE STAR PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:FIVE STAR PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SETTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-279-0317
Mailing Address - Street 1:P.O. BOX 2613
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-2613
Mailing Address - Country:US
Mailing Address - Phone:443-548-5700
Mailing Address - Fax:443-548-5705
Practice Address - Street 1:9715 HEALTHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:443-548-5700
Practice Address - Fax:443-548-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD539702400Medicaid
DC027430900Medicaid
DCG00431Medicare ID - Type UnspecifiedGROUP PROVIDER #
DC027430900Medicaid
MD539702400Medicaid