Provider Demographics
NPI:1578562484
Name:RUSHING, SYLVIA BURSON (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:BURSON
Last Name:RUSHING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:JANE
Other - Last Name:BURSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4300 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1054
Mailing Address - Country:US
Mailing Address - Phone:334-793-9564
Mailing Address - Fax:334-671-8907
Practice Address - Street 1:4300 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1054
Practice Address - Country:US
Practice Address - Phone:334-793-9564
Practice Address - Fax:334-671-8907
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014534207RC0000X
LA017394207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127015Medicaid
LA060016521OtherMEDICARE RAILROAD
LA1378992Medicaid
AL102I060475Medicare PIN
AL127015Medicaid
LA52083Medicare PIN
LA52038Medicare PIN
LA060016521Medicare UPIN