Provider Demographics
NPI:1639118938
Name:STRULSON, RICHARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:STRULSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1522
Mailing Address - Country:US
Mailing Address - Phone:215-624-0956
Mailing Address - Fax:215-624-3867
Practice Address - Street 1:3152 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1522
Practice Address - Country:US
Practice Address - Phone:215-624-0956
Practice Address - Fax:215-624-3867
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003888L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98460Medicare UPIN
404335Medicare ID - Type Unspecified