Individual
IRA R STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
230 N BROAD ST, PHILADELPHIA, PA 19102-1121
(215) 762-1808
(215) 762-4721
Mailing address
1500 MARKET ST, PHILADELPHIA, PA 19102-2100
(215) 255-3828
(215) 255-3577
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OS004175L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0371807
—
NJ
Enumeration date
07/29/2005
Last updated
08/12/2014
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