Provider Demographics
NPI:1184785354
Name:STRICKLAN, DAVID K (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:STRICKLAN
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 1:5201 WYNNEFIELD AVE
Mailing Address - Street 2:SUITE G-4
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2456
Mailing Address - Country:US
Mailing Address - Phone:215-878-7100
Mailing Address - Fax:215-878-1871
Practice Address - Street 1:5201 WYNNEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-2440
Practice Address - Country:US
Practice Address - Phone:215-878-7100
Practice Address - Fax:215-878-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049630-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0141388304Medicaid
PA123082OtherBLUE CROSS
PA123082OtherBLUE CROSS
PA0141388304Medicaid