Provider Demographics
NPI:1548217391
Name:STRICKBERGER, STANLEY ADAM (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:ADAM
Last Name:STRICKBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:ADAM
Other - Last Name:STRICKBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8081 INNOVATION PARK DR STE 602
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4867
Mailing Address - Country:US
Mailing Address - Phone:571-472-3270
Mailing Address - Fax:571-472-3271
Practice Address - Street 1:8081 INNOVATION PARK DR STE 602
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-3270
Practice Address - Fax:571-472-3271
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33670207RC0001X
VA0101253823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1170360OtherCOVENTRY
MD412031100Medicaid
DC63000001OtherNCA BLUE SHIELD
DCG02534OtherMEDICARE
DC0350563OtherCIGNA
DC4655075OtherAETNA
DC104681OtherAMERIGROUP
DC227930OtherKAISER
DC034338600Medicaid
DC2160871OtherMAMSI/OPTIMUM CHOICE/MDIPA
DC773416OtherNCPPO
DCDG0132OtherRAILROAD MEDICARE
VA5876907Medicaid
DC4655075OtherAETNA
DC2160871OtherMAMSI/OPTIMUM CHOICE/MDIPA
DC1170360OtherCOVENTRY