Provider Demographics
NPI:1235339219
Name:STRAUN, TEO-CARLO (MD)
Entity Type:Individual
Prefix:
First Name:TEO-CARLO
Middle Name:
Last Name:STRAUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 NEW BRITAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3165
Mailing Address - Country:US
Mailing Address - Phone:860-756-0455
Mailing Address - Fax:866-469-7058
Practice Address - Street 1:279 NEW BRITAIN RD STE A
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-3165
Practice Address - Country:US
Practice Address - Phone:860-756-0455
Practice Address - Fax:866-469-7058
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0508442084A0401X, 2084P0802X, 2084P0800X
MA2439252084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008068404Medicaid
CT004082260Medicaid
CT008001325Medicaid
CT008039745Medicaid
CTD400081206OtherGROUP MEMBER MEDICARE
CT004082286Medicaid
CT008022626Medicaid
CT008033575Medicaid
CT004041000Medicaid
CT008003745Medicaid
CT008022622Medicaid
CT500000315Medicaid
CT004217099Medicaid