MR. JEFFREY L STARK (NPI# 1356303630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356303630 |
| Entity Type | Individual |
| Full Name | MR. JEFFREY L STARK |
| Credential | PA-C |
| Practice Address |
5401 Old Court Rd Randallstown MD 21133-5103 |
| Mailing Address |
5401 Old Court Rd Attn: Credentialing Randallstown MD 21133-5103 |
| Practice Telephone | 4105212200 |
| Practice Fax Number | 4109226031 |
| Mailing Telephone | 4106015524 |
| Mailing Fax Number | 4106018946 |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2007-11-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
C00511 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679839799 | Jeffrey D Stark | Counselor | 1006 Wilson Rd, Wilmington, DE 19803-3449 | 2012-04-03 |
| 1912239468 | Jeffrey Eric Stark | Physician Assistant | 35 Gilbert Street, Cambridge Medical Center, Cambridge, NY 12816-2618 | 2010-02-09 |
| 1124112255 | Jeffrey Howard Stark | Podiatrist | 6216 Myrtle Ave, Glendale, NY 11385-6236 | 2006-10-03 |
| 1114922994 | Jeffrey M Stark | Podiatrist | 1 Duncan Pl, Oceanside, NY 11572-1306 | 2005-06-17 |
| 1275905952 | Jeffrey Stark | Pharmacist | 175 W Army Trail Rd, Glendale Heights, IL 60139-1971 | 2015-10-21 |
| 1568640621 | Jeffrey L Stark Jr. | Internal Medicine | 2959 Sharpsburg Mccollum Rd, Newnan, GA 30265 | 2008-01-31 |
| 1295809937 | Jeffrey David Stark | Optometrist | 2472 Broadway, New York, NY 10025-7449 | 2006-11-17 |
| 1598863748 | Jeffrey Ray Stark | Chiropractor | 11638 W Florissant Ave, Florissant, MO 63033-6723 | 2006-09-20 |
| Street Address |
5401 OLD COURT RD |
| City | RANDALLSTOWN |
| State | MD |
| Zip Code | 21133-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427054089 | Michael Holloway | Specialist | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2005-06-28 |
| 1235746231 | Brianne Elizabeth Leaf | Surgery | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-09-24 |
| 1528674132 | April Puskar | Nurse Practitioner | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-09-18 |
| 1790398659 | Jessica Stehman | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-08-28 |
| 1578176863 | Margot Wallace | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-08-26 |
| 1740805779 | Elizabeth M Atkinson | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-06-16 |
| 1316571722 | Morgan Ariel Murray | Nurse Practitioner | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-02-24 |
| 1811527278 | Ifeoma Jennifer Dunn | Nurse Practitioner | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-01-23 |
| 1598395725 | Ayodeji Bamidele Olawale | Nurse Practitioner | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-01-15 |
| 1336779578 | Lerin Jackson | Nurse Practitioner | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2020-01-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649898313 | Olivia David | Registered Nurse | 3525 Liberty Resource Drive, Randallstown, MD 21133 | 2020-07-09 |
| 1366082547 | Jerry Njomgert Christopher | Home Health Aide | 9106 Sandra Ct. Randallstown, Randallstown, MD 21133 | 2020-01-15 |
| 1487138913 | For Hope's Sake, LLC | Substance Abuse Rehabilitation Facility | 9905 Southhall Road, Randallstown, MD 21133 | 2018-09-20 |
| 1295214393 | Levindale Hebrew Geriatric Center & Hospital Inc | Clinic/Center | Lifebridge Health Adult Day Services, 5400 Old Court Road, Randallstown, MD 21133 | 2018-08-09 |
| 1235623968 | Away of Change Counseling Service, LLC | Counselor | 5310 Old Court Rd Ste 304, Randallstown, MD 21133 | 2018-06-16 |
| 1922503382 | Top Care Residential Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8607 Liberty Rd, Randallstown, MD 21133 | 2018-03-28 |
| 1497274880 | Yushika M Shepherd | In Home Supportive Care | 8911 Allenswood Rd, Randallstown, MD 21133 | 2017-09-17 |
| 1790208718 | Productive Lives Mental Health, LLC | Clinic/Center | Randallstown Medical Center 5310 Old Court Rd Suite 308, Randallstown, MD 21133 | 2017-07-21 |
| 1982136198 | Marla Rosanne Yee | Dentist | 5415 Old Court Road, Suite 01, Randallstown, MD 21133 | 2017-03-28 |
| 1598203549 | Traci Harris | Social Worker | 9633 Liberty Rd. (suites H&j), Randallstown, MD 21133 | 2017-02-09 |
| Find all providers in zip 21133 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730658436 | Megan Gibbons | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2018-11-26 |
| 1245706431 | Lisa Michelle Taylor | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2018-10-16 |
| 1689051567 | Chelsea Rene Smith | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2015-04-30 |
| 1538181888 | Kathleen A Ryan | Physician Assistant | 5401 Old Court Road, Northwest Hospital Center, Randallstown, MD 21133 | 2006-07-24 |
| 1316909898 | Ronaldo T Mendoza | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2006-04-03 |
| 1851353114 | Tiffany M Smith | Physician Assistant | 5401 Old Court Rd, Dept of Surgery, Randallstown, MD 21133-5103 | 2006-04-03 |
| 1285695098 | Jennifer L Barlow | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2006-03-31 |
| 1053372664 | Mindi N Valuckas | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2006-03-31 |
| 1679534200 | Christy M Crane | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2006-03-31 |
| 1528029600 | Lisa M Marroney | Physician Assistant | 5401 Old Court Rd, Dept. of Surgery, Randallstown, MD 21133-5103 | 2006-03-29 |
| Find all providers in RANDALLSTOWN | ||||
| City | RANDALLSTOWN |
| Zip Code | 21133 |
Please comment or provide details below to improve the information on MR. JEFFREY L STARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.