Organization
RANDOLPH W. STARK, M.D., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORMA J HEINRICH (OFFICE MANAGER)
(877) 257-9619
Entity
Organization
Contact information
Practice address
10680 CRESTWOOD DR STE B, MANASSAS, VA 20109-4402
(703) 361-6054
(703) 330-9095
Mailing address
10680 CRESTWOOD DR STE B, MANASSAS, VA 20109-4402
(703) 361-6054
(703) 330-9095
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101036334
VA
Other
Enumeration date
01/02/2008
Last updated
10/20/2009
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