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STARKS PEDIATRICS AT MALLARD CREEK PLLC NPI 1114131265


NPI Information

NPI: 1114131265
Provider Name: STARKS PEDIATRICS AT MALLARD CREEK, PLLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 34D1070725

Address:
2315 W. ARBORS DRIVE
SUITE 115
CHARLOTTE, NC
ZIP 28262
Phone: (704) 717-2826
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STARKS PEDIATRICS AT MALLARD CREEK, PLLC is a pediatrics in Charlotte, NC. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. STARKS PEDIATRICS AT MALLARD CREEK, PLLC NPI is 1114131265. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2315 W. ARBORS DRIVE
SUITE 115
CHARLOTTE, NC
ZIP 28262-639
Phone: (704) 717-2826
Fax: (704) 971-5014

The provider's authorized official is Lawanna Marie Starks .
The authorized official title is Owner and has the following contact phone number (704) 717-2826.

The CLIA number assigned to this NPI record is 34D1070725 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2007 and was last updated on 2/25/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics2006-00525NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15906849MEDICAIDNORTH CAROLINA
2H21433MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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