Provider Demographics
NPI:1144238825
Name:COLARUSSO, PATRICK J (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:COLARUSSO
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6TH AVE & SPRUCE ST REET
Practice Address - Street 2:N BUILDING / READING HOSPITAL REGIONAL CANCER CTR
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1428
Practice Address - Country:US
Practice Address - Phone:610-374-4404
Practice Address - Fax:610-374-1396
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007188L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001601293Medicaid
PA888602OtherMEDICARE PTAN
PA076296Medicare ID - Type Unspecified
PA0016012930003Medicaid