Provider Demographics
NPI:1033114244
Name:STRAUSS, KELLI ALISA (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:ALISA
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 412047
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13620 CRAYTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:240-313-9890
Practice Address - Fax:240-313-9891
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376491500Medicaid
MDKQ29200MMedicare ID - Type Unspecified
MD376491500Medicaid
MD141723ZABGMedicare PIN