Provider Demographics
NPI:1528048675
Name:STARK, KAREN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-227-6568
Mailing Address - Fax:503-227-3919
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 504
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-227-6568
Practice Address - Fax:503-227-3919
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24885207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28699Medicare UPIN
OR133381Medicare ID - Type Unspecified