Provider Demographics
NPI:1730195058
Name:STROUP, GERARD W (PA-C)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:W
Last Name:STROUP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SLEEPY HOLLOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5841
Mailing Address - Country:US
Mailing Address - Phone:302-364-2000
Mailing Address - Fax:302-329-8807
Practice Address - Street 1:102 SLEEPY HOLLOW DR STE 203
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-364-2000
Practice Address - Fax:302-329-8807
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP001029000363A00000X
DEC5-0000718363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076959P5LMedicare ID - Type Unspecified
NJQ09536Medicare UPIN