Provider Demographics
NPI:1548285133
Name:STROUP, RALPH F (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:F
Last Name:STROUP
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 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING SPECIALIST
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3174
Mailing Address - Fax:203-503-3183
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-09-06
Deactivation Date:2007-04-12
Deactivation Code:
Reactivation Date:2009-09-01
Provider Licenses
StateLicense IDTaxonomies
CT014484208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340000078Medicare ID - Type Unspecified
B39079Medicare UPIN