Provider Demographics
NPI:1548249816
Name:STRITTMATTER, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STRITTMATTER
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 1:5213 S. ALSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 -A PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2580
Practice Address - Country:US
Practice Address - Phone:919-693-3972
Practice Address - Fax:919-693-1700
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029417E207Q00000X
NC2012-01246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080084966OtherRAILROAD MEDICARE
PA50041795OtherCAPITAL BLUE CROSS
PAB37026OtherHEALTH ASSURANCE
PA0009985890001Medicaid
PA12233 S1QIOtherGEISINGER HEALTH PLAN
PA50060208OtherCAPITAL BLUE CROSS
PA50061979OtherCAPITAL BLUE CROSS
PA117199OtherHIGHMARK BLUE SHIELD
PA4527767OtherAETNA NON-HMO
PA50068269OtherCAPITAL BLUE CROSS
PA533036OtherAETNA HMO
PA01584601OtherCAPITAL BLUE CROSS
PA50043858OtherCAPITAL BLUE CROSS
PAP002648OtherGATEWAY HEALTH PLAN
PA50046249OtherCAPITAL BLUE CROSS
PA533036OtherAETNA HMO
PA50043858OtherCAPITAL BLUE CROSS
PA12233 S1QIOtherGEISINGER HEALTH PLAN