NPIMap

Organization Active NPI

Randolph W. Stark, M.D., PA

  • Specialist
  • Manassas, VA
National Provider Identifier
1639354244
Registry record updated Oct 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
0101036334 Issued in VA
Legal business name
RANDOLPH W. STARK, M.D., PA
Practice address
10680 Crestwood Dr Ste B
Manassas, VA 20109-4402
Phone
(703) 361-6054
Fax
(703) 330-9095
NPI assigned
Jan 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Norma J Heinrich
Title
Office Manager
Phone
(877) 257-9619

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 0101036334 VA Primary

Addresses

Primary practice location

10680 Crestwood Dr Ste B
Manassas, VA 20109-4402

Mailing address

10680 Crestwood Dr Ste B
Manassas, VA 20109-4402
Phone (703) 361-6054

National Provider Directory

National Provider Directory

Locations

10680 Crestwood Dr
Ste B
Manassas, VA 20109
Phone (703) 361-6054

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255996800000",
    "number": "1639354244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10680 CRESTWOOD DR STE B",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094402",
            "telephone_number": "703-361-6054",
            "fax_number": "703-330-9095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10680 CRESTWOOD DR STE B",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201094402",
            "telephone_number": "703-361-6054",
            "fax_number": "703-330-9095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH W. STARK, M.D., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-02",
        "last_updated": "2009-10-20",
        "status": "A",
        "authorized_official_last_name": "HEINRICH",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "877-257-9619",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "VA",
            "license": "0101036334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.