Provider Demographics
NPI:1689894669
Name:STEPHEN D. STARR, M.D. & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:STEPHEN D. STARR, M.D. & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-756-0470
Mailing Address - Street 1:354 W BOYLSTON ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2373
Mailing Address - Country:US
Mailing Address - Phone:508-756-0470
Mailing Address - Fax:508-756-0471
Practice Address - Street 1:354 W BOYLSTON ST
Practice Address - Street 2:SUITE 224
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:508-756-0470
Practice Address - Fax:508-756-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18884OtherBC BS MASSACHUSETTS