Provider Demographics
NPI:1124327101
Name:PEARSON, STARR PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:PATRICIA
Last Name:PEARSON
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 1:7715 CRITTENDEN ST # 115
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4421
Mailing Address - Country:US
Mailing Address - Phone:215-205-3724
Mailing Address - Fax:215-205-3723
Practice Address - Street 1:7715 CRITTENDEN ST # 115
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-4421
Practice Address - Country:US
Practice Address - Phone:215-205-3724
Practice Address - Fax:215-205-3723
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-044523E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E66020Medicare UPIN