Provider Demographics
NPI:1710325238
Name:STARK, AMANDA (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VCUHS GME ADMINISTRATION BOX 980257
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1001 E LEIGH ST DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23291-5051
Practice Address - Country:US
Practice Address - Phone:804-828-7232
Practice Address - Fax:804-828-7981
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2024-06-30
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101260011208000000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics