Provider Demographics
NPI:1790744043
Name:STROUSE, WAYNE STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:STEVEN
Last Name:STROUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:108 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1816
Mailing Address - Country:US
Mailing Address - Phone:315-536-2273
Mailing Address - Fax:315-531-3056
Practice Address - Street 1:108 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1816
Practice Address - Country:US
Practice Address - Phone:315-536-2273
Practice Address - Fax:315-531-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY199367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine