Provider Demographics
NPI:1306931787
Name:STRADER, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:STRADER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 95000 LB# 7550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:80 BLOOMFIELD AVENUE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5342
Practice Address - Country:US
Practice Address - Phone:973-618-9990
Practice Address - Fax:973-618-9991
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04997100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K3416OtherHEALTHNET
NJP414950OtherOXFORD
NJ4274162OtherAETNA
NJ223685542OtherTAX ID
NJ836002OtherUNITED HEALTHCARE
NJ23E181OtherEMPIRE
NJ413847OtherCIGNA
NJJ7678OtherHORIZON MANAGED CARE