Provider Demographics
NPI:1720075971
Name:STARR, PHILIP A III (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:STARR
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 TOD PL NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2474
Mailing Address - Country:US
Mailing Address - Phone:330-841-4643
Mailing Address - Fax:330-841-4644
Practice Address - Street 1:1296 TOD PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2474
Practice Address - Country:US
Practice Address - Phone:330-841-4643
Practice Address - Fax:330-841-4644
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263545Medicaid
ST4053031Medicare ID - Type Unspecified
OH2263545Medicaid