Provider Demographics
NPI:1548301393
Name:RICHARD F. LATUSKA, M.D.
Entity type:Organization
Organization Name:RICHARD F. LATUSKA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LATUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-482-0095
Mailing Address - Street 1:102 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1784
Mailing Address - Country:US
Mailing Address - Phone:724-482-0095
Mailing Address - Fax:724-482-2033
Practice Address - Street 1:102 TECHNOLOGY DR
Practice Address - Street 2:SUITE 230
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1782
Practice Address - Country:US
Practice Address - Phone:724-482-0095
Practice Address - Fax:724-482-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038916E207RG0100X
PAOS007169L207RG0100X
PAMD025407E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017486240006Medicaid
PA0017486240006Medicaid