Provider Demographics
NPI:1831137751
Name:SCHUSTER, GRAE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GRAE
Middle Name:LEE
Last Name:SCHUSTER
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 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-3535
Mailing Address - Fax:814-375-3563
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:PENN HIGHLANDS RADIATION ONCOLOGY
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-375-3535
Practice Address - Fax:814-375-3563
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE184672085R0001X
OH350916172085R0001X
PAMD4518932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2859518Medicaid
NEA03532Medicare UPIN
NE099620Medicare ID - Type Unspecified
OH2859518Medicaid