Provider Demographics
NPI:1598766131
Name:BUSCH, GREGORY H (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5 EVES DR
Mailing Address - Street 2:SUITE 120 A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3135
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0346
Practice Address - Street 1:1561 ROUTE 38
Practice Address - Street 2:SUITE 6
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2939
Practice Address - Country:US
Practice Address - Phone:609-267-2100
Practice Address - Fax:609-267-6921
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2014-03-25
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08068700207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001943718Medicaid
H78676Medicare UPIN
NJ067280Medicare ID - Type Unspecified