Provider Demographics
NPI:1770529935
Name:RUSHTON, SCOTT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:RUSHTON
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 1:100 E LANCASTER AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-3005
Mailing Address - Fax:610-649-4367
Practice Address - Street 1:100 E LANCASTER AVE STE 280
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-642-3005
Practice Address - Fax:610-649-4367
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056594L207XS0117X
DEC10007827207XS0117X
NJ25MA07199900207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG92976Medicare UPIN
NJ046550Medicare ID - Type Unspecified
PA0225162000OtherI.B.C.
PA2353850OtherAETNA
PAG92976Medicare UPIN