Healthcare Provider Details

I. General information

NPI: 1285657767
Provider Name (Legal Business Name): IRA STRASSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WEST LANCASTER AVE SUITE 340
PAOLI PA
19301
US

IV. Provider business mailing address

250 WEST LANCASTER AVE SUITE 340
PAOLI PA
19301
US

V. Phone/Fax

Practice location:
  • Phone: 610-407-9000
  • Fax: 610-407-9005
Mailing address:
  • Phone: 610-407-9000
  • Fax: 610-407-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-043367-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: