Provider Demographics
NPI:1659254407
Name:STARK, MARY CLAIRE (PA-C)
Entity type:Individual
Prefix:
First Name:MARY CLAIRE
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9820 OLD WATERFORD RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-5668
Mailing Address - Country:US
Mailing Address - Phone:814-602-0977
Mailing Address - Fax:
Practice Address - Street 1:6535 NEMOURS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7884
Practice Address - Country:US
Practice Address - Phone:407-650-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant