Provider Demographics
NPI:1902087828
Name:STRITTER, GWENDOLYN M (MD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:STRITTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 LAS TRANCOS RD
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-8125
Mailing Address - Country:US
Mailing Address - Phone:650-851-0377
Mailing Address - Fax:
Practice Address - Street 1:1235 LAS TRANCOS RD
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-8125
Practice Address - Country:US
Practice Address - Phone:650-851-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58915207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF00921Medicare UPIN