Basic Information
| Provider Information | |||||||||
| NPI: | 1154355683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRADER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 ROWLAND ST | ||||||||
| Address2: | |||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120201135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188856721 | ||||||||
| FaxNumber: | 5188855412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 138647 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 691701 | 01 | NY | EMPIRE BC | OTHER | 070226000032 | 01 | NY | FIDELIS | OTHER | 000401235002 | 01 | NY | BSNENY | OTHER | 10001986 | 01 | NY | CDPHP | OTHER | 47361 | 01 | NY | GHI/HMO | OTHER | 200205 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 7509288 | 01 | NY | AETNA | OTHER | 00605601 | 05 | NY | MEDICAID | 08118 | 01 | NY | MVP | OTHER |