Provider Demographics
NPI:1578319455
Name:STARK, MAGGIE ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ELIZABETH
Last Name:STARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HIGH ROCK LN
Mailing Address - Street 2:
Mailing Address - City:NEWFIELDS
Mailing Address - State:NH
Mailing Address - Zip Code:03856-8233
Mailing Address - Country:US
Mailing Address - Phone:603-686-4156
Mailing Address - Fax:
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP06215207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services