Provider Demographics
NPI: | 1467744615 |
---|---|
Name: | RUSHING, ERICA C (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ERICA |
Middle Name: | C |
Last Name: | RUSHING |
Suffix: | |
Gender: | F |
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: | 14275 MIDWAY ROAD |
Mailing Address - Street 2: | SUITE 400 |
Mailing Address - City: | ADDISON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75001-3676 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-257-0117 |
Mailing Address - Fax: | 610-271-4245 |
Practice Address - Street 1: | 3805 WEST CHESTER PIKE |
Practice Address - Street 2: | BLDG D, SUITE 120 |
Practice Address - City: | NEWTOWN SQUARE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19073-2304 |
Practice Address - Country: | US |
Practice Address - Phone: | 800-257-0117 |
Practice Address - Fax: | 610-550-3079 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-05-06 |
Last Update Date: | 2016-08-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD441580 | 207ND0900X |
NC | 2012-00971 | 207ZD0900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ND0900X | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 5920802 | Medicaid | |
NC | 5920802 | Medicaid |