Provider Demographics
NPI:1851389282
Name:STARR, VIVIAN I (DO)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:I
Last Name:STARR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 PARMALEE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1653
Mailing Address - Country:US
Mailing Address - Phone:330-747-8611
Mailing Address - Fax:
Practice Address - Street 1:602 PARMALEE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1653
Practice Address - Country:US
Practice Address - Phone:330-747-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199446Medicaid
OH2199446Medicaid
H17908Medicare UPIN