Provider Demographics
NPI:1760483325
Name:STROSAHL, KURT FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:FREDERICK
Last Name:STROSAHL
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3525
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:612 KINGSBOROUGH SQ
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5041
Practice Address - Country:US
Practice Address - Phone:757-547-9294
Practice Address - Fax:757-213-9342
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 232412207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005870291Medicaid
VAH59782Medicare UPIN
VA005870291Medicaid