Healthcare Provider Details

I. General information

NPI: 1467598185
Provider Name (Legal Business Name): DONALD RICHARD STRAUB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8262 ATLEE RD MOB III SUITE 205
MECHANICSVILLE VA
23116-1816
US

IV. Provider business mailing address

8262 ATLEE RD MOB III SUITE 205
MECHANICSVILLE VA
23116-1816
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-0194
  • Fax: 804-559-0198
Mailing address:
  • Phone: 804-559-0194
  • Fax: 804-559-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA13000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: