Provider Demographics
NPI:1184722258
Name:STRAYHORN, WILLIAM DAVID IV (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:STRAYHORN
Suffix:IV
Gender:M
Credentials:MD, PHD
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 1806
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0806
Mailing Address - Country:US
Mailing Address - Phone:240-566-3130
Mailing Address - Fax:240-566-3131
Practice Address - Street 1:196 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4397
Practice Address - Country:US
Practice Address - Phone:240-566-3130
Practice Address - Fax:240-566-3131
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040247612084N0400X
MDD0071626204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009001301OtherMO LICENSE
MD131347ZAPQMedicare PIN
MD131347ZAPQMedicare PIN