Provider Demographics
NPI:1174625024
Name:STARR, ERIC WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:STARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5560
Mailing Address - Fax:704-316-5561
Practice Address - Street 1:10030 GILEAD RD
Practice Address - Street 2:SUITE 360
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-316-5560
Practice Address - Fax:704-316-5561
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174625024Medicaid
NC0579PAOtherSC MEDICAID
NC8101189Medicaid
NC2768140NMedicare PIN
NC2768140UMedicare PIN
NC2768140AMedicare PIN
NC2768140PMedicare PIN
NC2768140TMedicare PIN
NC2768140FMedicare PIN
NC2768140JMedicare PIN
NC2768140KMedicare PIN
NC2768140BMedicare PIN
NC0579PAOtherSC MEDICAID
NC1174625024Medicaid
NC2768140HMedicare PIN
NC2768140EMedicare PIN
NC2768140SMedicare PIN
NC2768140GMedicare PIN
NC8101189Medicaid
NC2768140RMedicare PIN