Provider Demographics
NPI:1902035181
Name:STEPHEN IRA STARK, M.D., INC
Entity Type:Organization
Organization Name:STEPHEN IRA STARK, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPA
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-920-1604
Mailing Address - Street 1:2825 J ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-446-3777
Mailing Address - Fax:916-446-3788
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 235
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-446-3777
Practice Address - Fax:916-446-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G602000Medicaid
CA00G602000Medicaid
CK413ZMedicare PIN
CA00G602000Medicare PIN
CAA53563Medicare UPIN