Provider Demographics
NPI:1730174756
Name:KUSHON, DONALD J (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:KUSHON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:FAIRBANKS MEMORIAL HOSPITAL
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-458-5525
Practice Address - Fax:907-458-5514
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-05-12
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Provider Licenses
StateLicense IDTaxonomies
PAMD042233E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E73769Medicare UPIN