Organization
VIRGINIA STARK-VANCE, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA STARK-VANCE M.D. (OWNER)
(817) 926-2555
Entity
Organization
Contact information
Practice address
1325 PENNSYLVANIA AVE, SUITE 120, FORT WORTH, TX 76104-2158
(817) 926-2555
(817) 926-2519
Mailing address
1325 PENNSYLVANIA AVE, SUITE 120, FORT WORTH, TX 76104-2158
(817) 926-2555
(817) 926-2519
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
J9819
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900003253
RR MEDICARE
TX
Enumeration date
06/24/2009
Last updated
08/27/2009
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