Provider Demographics
NPI:1881736403
Name:STRAUSS, EDWARD J (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2433
Mailing Address - Country:US
Mailing Address - Phone:215-728-6500
Mailing Address - Fax:
Practice Address - Street 1:7604 CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2433
Practice Address - Country:US
Practice Address - Phone:215-728-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004043L207QA0505X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4220OtherUS HEALTHCARE
PAPA10253OtherQUALMED
PAST994090OtherBLUE SHIELD
PA0848948Medicaid
PA47153OtherMERCY NON-PART
PA0848948OtherDPA
PA923629OtherKEYSTONE
PAST406059Medicare ID - Type Unspecified
PA4220OtherUS HEALTHCARE