Provider Demographics
NPI:1386107829
Name:STRAUSBURG DERMATOLOGY GROUP LLC
Entity type:Organization
Organization Name:STRAUSBURG DERMATOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRAUSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-403-1903
Mailing Address - Street 1:6938 BLUFFGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2806
Mailing Address - Country:US
Mailing Address - Phone:317-403-1903
Mailing Address - Fax:
Practice Address - Street 1:92 S PARK BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8836
Practice Address - Country:US
Practice Address - Phone:317-889-7546
Practice Address - Fax:317-889-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty