Provider Demographics
NPI:1407363542
Name:STARNER, PAUL ALLEN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALLEN
Last Name:STARNER
Suffix:
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 1:3102 HEMLOCK POINT CT
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-1509
Mailing Address - Country:US
Mailing Address - Phone:573-353-9482
Mailing Address - Fax:
Practice Address - Street 1:3102 HEMLOCK POINT CT
Practice Address - Street 2:
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-1509
Practice Address - Country:US
Practice Address - Phone:573-353-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications