Provider Demographics
NPI:1245273903
Name:STARCK, REBECCA N (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:STARCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36901 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-930-6200
Mailing Address - Fax:440-930-6201
Practice Address - Street 1:36901 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-930-6200
Practice Address - Fax:440-930-6201
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2160414Medicaid
OH2160414Medicaid
OH0894774Medicare PIN
OH7332771Medicare PIN