Provider Demographics
NPI:1063466712
Name:STARADUB, VALERIE L (MD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:L
Last Name:STARADUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 OGLETOWN STANTON RD STE 1500
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-7022
Practice Address - Country:US
Practice Address - Phone:302-623-4343
Practice Address - Fax:302-623-4203
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222993174400000X, 208600000X
DEC1-0024031208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2086051Medicaid
MA3654536OtherAETNA NONHMO
MA467586OtherTUFTS HEALTH PLANS
MA91713OtherFALLON
MAG07488OtherHARVARD PILGRIM
MA0034200OtherNEIGHBORHOOD HEALTH PLAN
MA17-01748OtherUNITED HEALTHCARE
MAJ28196OtherBLUE CROSS ALL
MA21251156949OtherBEECH STREET
MA8956442OtherCIGNA
MA7543310OtherAETNA HMO
MAJ28196OtherBLUE CROSS ALL
MA2086051Medicaid