Provider Demographics
NPI:1306077912
Name:STRACKE, CARSTEN P (MD)
Entity type:Individual
Prefix:DR
First Name:CARSTEN
Middle Name:P
Last Name:STRACKE
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 1:454 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5532
Mailing Address - Country:US
Mailing Address - Phone:518-587-1141
Mailing Address - Fax:518-587-1152
Practice Address - Street 1:211 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1003
Practice Address - Country:US
Practice Address - Phone:518-583-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263438207Q00000X, 207P00000X
WI65651-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCFP-263438-4BOtherWORKERS COMPENSATION BOARD AUTHORIZATION
2100991563OtherNATIONAL REGISTRY OF CERTIFIED MEDICAL EXAMINERS