Provider Demographics
NPI:1508801085
Name:ROUSH, ROBERT K JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:ROUSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 LAWRENCE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3301
Mailing Address - Country:US
Mailing Address - Phone:610-492-5900
Mailing Address - Fax:610-492-5903
Practice Address - Street 1:30 LAWRENCE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3301
Practice Address - Country:US
Practice Address - Phone:610-492-5900
Practice Address - Fax:610-492-5903
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036281E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5757046OtherAETNA TRADITIONAL
PA0483313000OtherIBC
PA0515620OtherAETNA HMO
PA651980OtherBLUE SHIELD
PA651980P4UMedicare PIN
PA0483313000OtherIBC