Basic Information
| Provider Information | |||||||||
| NPI: | 1821119199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENRY J STARR, MD, PA | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5711 SARVIS AVE | ||||||||
| Address2: | #402 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207371394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012774844 | ||||||||
| FaxNumber: | 3019253221 | ||||||||
| Practice Location | |||||||||
| Address1: | 5711 SARVIS AVE | ||||||||
| Address2: | #402 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207371394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012774844 | ||||||||
| FaxNumber: | 3019273221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STARR | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3012774844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0011807 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 23231 | 01 | MAMSI | OTHER |