Provider Demographics
NPI:1700978392
Name:KUSH, MARY KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:KUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 STATE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4420
Mailing Address - Country:US
Mailing Address - Phone:717-243-4257
Mailing Address - Fax:717-243-4268
Practice Address - Street 1:25 STATE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4420
Practice Address - Country:US
Practice Address - Phone:717-243-4257
Practice Address - Fax:717-243-4268
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017472E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH61130Medicare UPIN
PAP00436996Medicare PIN
PA113784Medicare PIN