Provider Demographics
NPI:1831109271
Name:EARL C . STRAYHORN M.D., P.C.
Entity Type:Organization
Organization Name:EARL C . STRAYHORN M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:BLOCKER-PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, MA
Authorized Official - Phone:757-461-4278
Mailing Address - Street 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 317 B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-461-4278
Mailing Address - Fax:757-461-1494
Practice Address - Street 1:6160 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 317 B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3933
Practice Address - Country:US
Practice Address - Phone:757-461-4278
Practice Address - Fax:757-461-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010357882086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7304994Medicaid
VA7304994Medicaid