Provider Demographics
NPI:1164409678
Name:NUSSBAUM, MICHAEL LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LYNN
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-887-3990
Mailing Address - Fax:215-887-1140
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-887-3990
Practice Address - Fax:215-887-1140
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-038733E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA265028OtherBLUE CROSS BLUE SHIELD
PA0012574100008Medicaid
PA1002111OtherAETNA
PA0072656000OtherKEYSTONE
PA020054344OtherRAILROAD MEDICARE
PW7290859004OtherCIGNA
PA0012574100008Medicaid
PA0072656000OtherKEYSTONE