Eric Wygant Stark, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

01030271A Issued in IN

Practice address

2400 South St
Lafayette, IN 47904-3027

Phone

(765) 448-4319

Fax

(765) 448-2821

NPI assigned

Jul 9, 2005

Last updated

Jul 16, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Diagnostic Services LLP

  • Anatomic Pathology & Clinical Pathology Physician
  • Lafayette, IN
  • NPI 1790783074
  NPD

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

{
    "created_epoch": "1120867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1750389169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5628",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479035628",
            "telephone_number": "765-448-4319",
            "fax_number": "765-448-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 SOUTH ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479043027",
            "telephone_number": "765-448-4319",
            "fax_number": "765-448-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "ERIC",
        "middle_name": "WYGANT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-09",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01030271A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "111890E",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CA8380",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000082506",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "176600B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Vincent Seton Specialty Hospital, Inc.
• Nick Stachelski
• Elizabeth Standish, D.D.S., M.S.D.
• Haiden Stanton
• Nicole Stapleton, CST
• James Allen Starkweather, ATC
• Carol Irene Starr, LCSW ACSW
• Erika Louann Statler, LCSW
• Matthew Charles Steadham, DPT
• Ginger Ann Stedwell-Smith, NP

• Anatomic Pathology & Clinical Pathology Physician in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.