Provider Demographics
NPI:1134616626
Name:JOAN E STRAWSON, LLC
Entity type:Organization
Organization Name:JOAN E STRAWSON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:910-528-9768
Mailing Address - Street 1:237 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6526
Mailing Address - Country:US
Mailing Address - Phone:910-528-9768
Mailing Address - Fax:
Practice Address - Street 1:1298 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-6300
Practice Address - Country:US
Practice Address - Phone:910-528-9768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02340261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center