Provider Demographics
NPI:1134693310
Name:RAN STARK MD PC
Entity Type:Organization
Organization Name:RAN STARK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-482-8809
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0012
Mailing Address - Country:US
Mailing Address - Phone:484-482-8809
Mailing Address - Fax:
Practice Address - Street 1:135 S BRYN MAWR AVE STE 220
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3129
Practice Address - Country:US
Practice Address - Phone:484-482-8809
Practice Address - Fax:484-380-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty