Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 0101049468 | VA |
NPI | 1003428947 |
---|---|
Provider Name | Dr. Constantine A Stratakis |
First Address | North Bethesda, MD 20852-3745 |
Second Address | Bethesda, MD 20892-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2020 |
Last Update Date | 21/08/2020 |