Provider Demographics
NPI:1154847812
Name:STARKE, WAYNE SR
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:STARKE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19718 MANSON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC KENNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23872-2844
Mailing Address - Country:US
Mailing Address - Phone:804-526-5820
Mailing Address - Fax:
Practice Address - Street 1:19718 MANSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:MC KENNEY
Practice Address - State:VA
Practice Address - Zip Code:23872-2844
Practice Address - Country:US
Practice Address - Phone:804-526-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver