Provider Demographics
NPI:1730232141
Name:PAUL J RUSCHAK MD PC
Entity type:Organization
Organization Name:PAUL J RUSCHAK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-483-5507
Mailing Address - Street 1:100 STOOPS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-3553
Mailing Address - Country:US
Mailing Address - Phone:724-483-5507
Mailing Address - Fax:724-483-0530
Practice Address - Street 1:100 STOOPS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-3553
Practice Address - Country:US
Practice Address - Phone:724-483-5507
Practice Address - Fax:724-483-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017990E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA204486OtherUPMC HEALTH PLAN
PA070014620OtherPALMETTO GBA RAILROAD
PA073226OtherHIGHMARK BLUE SHIELD
PA128758OtherHIGHMARK BS BC -INDIVID
PA097321OtherUNISON ADVANTAGE MEDICARE
PA095625Medicare ID - Type Unspecified
PA070014620OtherPALMETTO GBA RAILROAD