Individual
VITALIY STAROSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102
(701) 234-2525
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
12702
ND
208M00000X
Hospitalist Physician
Primary
12702
ND
282N00000X
General Acute Care Hospital
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336443233
—
MN
05
—
18151
—
ND
Enumeration date
01/06/2011
Last updated
08/01/2018
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