Provider Demographics
NPI:1508041682
Name:JOHN R RUSHTON III MD PA
Entity Type:Organization
Organization Name:JOHN R RUSHTON III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUSHTON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:856-354-1800
Mailing Address - Street 1:101 CHANDLER TER
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3601
Mailing Address - Country:US
Mailing Address - Phone:856-354-1800
Mailing Address - Fax:856-354-0792
Practice Address - Street 1:101 CHANDLER TER
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3601
Practice Address - Country:US
Practice Address - Phone:856-354-1800
Practice Address - Fax:856-354-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA13059305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMC D06144Medicare UPIN
NJ031542Medicare PIN