Provider Demographics
NPI:1639386618
Name:STRACENSKY, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:STRACENSKY
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:P.O. BOX LBJ TMC
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0001
Mailing Address - Country:US
Mailing Address - Phone:684-633-1683
Mailing Address - Fax:684-633-5107
Practice Address - Street 1:96799 TURNER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0001
Practice Address - Country:US
Practice Address - Phone:684-633-1683
Practice Address - Fax:684-633-5107
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-02-04
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2009-02-04
Provider Licenses
StateLicense IDTaxonomies
ASB12345207PE0004X
ASSS77684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS640001Medicare Oscar/Certification
ASH53718Medicare PIN