Provider Demographics
NPI:1417187089
Name:STARK HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:STARK HEALTH SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:301-317-0020
Mailing Address - Street 1:5604 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-4205
Mailing Address - Country:US
Mailing Address - Phone:410-227-8898
Mailing Address - Fax:301-317-0028
Practice Address - Street 1:5604 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-4205
Practice Address - Country:US
Practice Address - Phone:410-227-8898
Practice Address - Fax:301-317-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR083302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ214-0001OtherBCBS
MDNA44BOtherBCBS
MD401937700Medicaid