Provider Demographics
NPI:1003428947
Name:STRATAKIS, CONSTANTINE A (MD, D(MED)SCI, PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:A
Last Name:STRATAKIS
Suffix:
Gender:M
Credentials:MD, D(MED)SCI, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 TILDEN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3745
Mailing Address - Country:US
Mailing Address - Phone:301-315-2178
Mailing Address - Fax:
Practice Address - Street 1:9000 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049468207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)