Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 151409 | NY |
NPI | 1265407902 |
---|---|
Provider Name | Dr. Thomas Starc |
First Address | San Diego, CA 92114-7167 |
Second Address | New York, NY 10032-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 22/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00952218 | (05) | NY |
H78655 | (02) | NY |