Provider Demographics
NPI:1598840779
Name:STROUD, JOAN A (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:STROUD
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 1:201 EASTERN PKWY APT 6K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6138
Mailing Address - Country:US
Mailing Address - Phone:718-398-3056
Mailing Address - Fax:718-857-2628
Practice Address - Street 1:97 AMITY ST
Practice Address - Street 2:LICH FAMILY MEDICINE DEPT. 4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6004
Practice Address - Country:US
Practice Address - Phone:718-780-1948
Practice Address - Fax:718-780-4639
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00690941Medicaid
AX1991Medicare ID - Type Unspecified
G78341Medicare UPIN