Provider Demographics
NPI:1700990561
Name:STRATIGOS, ALICE MAYNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MAYNARD
Last Name:STRATIGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 HAWTHORNE WAY
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3004
Mailing Address - Country:US
Mailing Address - Phone:914-437-8456
Mailing Address - Fax:914-437-8456
Practice Address - Street 1:29 HAWTHORNE WAY
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3004
Practice Address - Country:US
Practice Address - Phone:914-437-8456
Practice Address - Fax:914-437-8456
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045708208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC42788Medicare UPIN
ILC42788Medicare UPIN