Provider Demographics
NPI:1063499382
Name:AUSMAN, EDWARD J (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:AUSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 ELK ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1619
Mailing Address - Country:US
Mailing Address - Phone:814-432-2658
Mailing Address - Fax:
Practice Address - Street 1:POLK CENTER
Practice Address - Street 2:100 LAKEWOOD CIRCLE
Practice Address - City:POLK
Practice Address - State:PA
Practice Address - Zip Code:16342-0094
Practice Address - Country:US
Practice Address - Phone:814-432-0471
Practice Address - Fax:814-432-0179
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS4278L207Q00000X
WAOP1362207Q00000X
CO35670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01356708Medicaid
PAF29067Medicare UPIN
PA01356708Medicaid
PAP00395697Medicare PIN
PA108791Medicare PIN