Provider Demographics
NPI:1700846961
Name:STRAUSS, PETER GLEN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GLEN
Last Name:STRAUSS
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 1:2084 MARSHALLS LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2825
Mailing Address - Country:US
Mailing Address - Phone:718-208-5267
Mailing Address - Fax:
Practice Address - Street 1:1645 TULLIE CIR NE
Practice Address - Street 2:DIVISION OF PEDIATRIC EMERGENCY SERVICES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2304
Practice Address - Country:US
Practice Address - Phone:404-785-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060999208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics