Provider Demographics
NPI:1700086741
Name:STARKS, BRADLY WADE (DO)
Entity Type:Individual
Prefix:
First Name:BRADLY
Middle Name:WADE
Last Name:STARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:282 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023-8827
Practice Address - Country:US
Practice Address - Phone:717-362-3371
Practice Address - Fax:717-362-4278
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2021-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022157030007Medicaid
PA135350Medicare PIN
PAST2068527OtherHIGHMARK BLUE SHIELD