Provider Demographics
NPI:1508209206
Name:RADUSKY, ROSS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:CHARLES
Last Name:RADUSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 HARVEST HILL RD STE 138
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5806
Mailing Address - Country:US
Mailing Address - Phone:972-661-2729
Mailing Address - Fax:
Practice Address - Street 1:5310 HARVEST HILL RD STE 138
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-5806
Practice Address - Country:US
Practice Address - Phone:972-661-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287864207N00000X
TXS8898207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty