Provider Demographics
NPI:1548229305
Name:NUSZ, KEVIN J (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:NUSZ
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 1:1240 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2200
Mailing Address - Country:US
Mailing Address - Phone:803-285-4333
Mailing Address - Fax:803-285-3472
Practice Address - Street 1:1240 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2200
Practice Address - Country:US
Practice Address - Phone:803-285-4333
Practice Address - Fax:803-285-3472
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239443207W00000X
NC2007-00829207W00000X
SC29793207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN894699000Medicaid
MN894699000Medicaid
MN180001128Medicare ID - Type Unspecified
MNP00045107Medicare ID - Type UnspecifiedRAILROAD