Provider Demographics
NPI:1134502453
Name:LUSCHER, JUDITH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:LUSCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:ELLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:99 N BRICE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6510
Mailing Address - Country:US
Mailing Address - Phone:614-866-9200
Mailing Address - Fax:614-326-0085
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6510
Practice Address - Country:US
Practice Address - Phone:614-866-9200
Practice Address - Fax:614-326-0085
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant