Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101028190 | VA |
NPI | 1003864372 |
---|---|
Provider Name | Dr. James J Stark |
First Address | Suffolk, VA 23435-2657 |
Second Address | Suffolk, VA 23435-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15878 | SENTARA/OPTIMA (01) | VA |
208484 | ANTHEM BCBS (01) | VA |
3536407004 | CIGNA (01) | VA |
4004872 | AETNA (01) | VA |
656352 | MAMSI (INTERNAL) (01) | VA |
8906547 | NORTH CAROLINA MEDICAID (01) | NC |
956352 | MAMSI (ONCOLOGY) (01) | VA |
C47541 | (02) | VA |