Provider Demographics
NPI:1225250756
Name:STARR, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:STARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E HIGH ST
Mailing Address - Street 2:PO BOX 615
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1261
Mailing Address - Country:US
Mailing Address - Phone:740-506-0910
Mailing Address - Fax:740-852-7762
Practice Address - Street 1:62 S OAK ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140
Practice Address - Country:US
Practice Address - Phone:740-506-0910
Practice Address - Fax:740-852-7762
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-4351251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA70535Medicare UPIN