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Deactivated NPI 1164422994 Deactivated / Inactive NPI Male Practitioner

Dr. Randolph W Stark , MD PA

Specialist • Manassas, VA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Randolph Stark has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 22, 2005
NPI Deactivation Date April 17, 2024
Total Practice Duration ~19 Years of Practice (2005 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Randolph Stark, MD PA was a registered Specialist practicing in Manassas, VA. Throughout an active medical career spanning 19 years, Dr. Stark provided care at the practice location at 10680 CRESTWOOD DR STE B until profile deactivation on 2024-04-17.

Practice Location & Contact Primary Location

Practice Address

10680 Crestwood Dr Ste B

Manassas, VA 201094402

Telephone 7033616054
Fax 7033309095
Associated Practice Facility / Clinic
🏢 Randolph W. Stark, M.d., Pa Facility NPI 1639354244

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Manassas, VA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 37.5 Yrs
Regional Practice Density
11 Specialists

Practicing in Manassas, VA (878 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License VA 0101036334

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 17, 2024

Record deactivated on April 17, 2024

NPI Profile Active October 20, 2009

NPI status registered as active in NPPES database

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Updated Practice Location October 20, 2009

Registered at 10680 CRESTWOOD DR STE B, MANASSAS, VA 201094402 (Tel: 7033616054)

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Updated Business Mailing Address October 20, 2009

Registered at 10680 CRESTWOOD DR STE B, MANASSAS, VA 201094402 (Tel: 7033616054)

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Provider Name / Credentials Updated October 20, 2009

Recorded as RANDOLPH STARK, M.D. PA

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 20, 2009

Specialist (License #0101036334 in VA)

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Initial NPI Registration & Enumeration July 22, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164422994
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 22, 2005
Last Update: October 20, 2009
Deactivation Date: April 17, 2024

Mailing Address

10680 Crestwood Dr Ste B

Manassas, VA 201094402

Phone: 7033616054

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.