Provider Demographics
NPI: | 1013906643 |
---|---|
Name: | KEARNEY, STARR (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | STARR |
Middle Name: | |
Last Name: | KEARNEY |
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: | 245 GROVE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | RIDGWAY |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15853-1913 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-772-8463 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 763 JOHNSONBURG RD |
Practice Address - Street 2: | ELK REGIONAL PROFESSIONAL GROUP, INC. |
Practice Address - City: | ST MARYS |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15857-3417 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-788-8580 |
Practice Address - Fax: | 814-788-8092 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-10-17 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS005318 I | 207P00000X |
PA | OS005318L | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 183236 | Medicare ID - Type Unspecified | |
D71394 | Medicare UPIN |