Provider Demographics
NPI:1609873991
Name:SHUSMAN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:SHUSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 PARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4202
Mailing Address - Country:US
Mailing Address - Phone:484-422-8080
Mailing Address - Fax:484-422-8073
Practice Address - Street 1:9 N BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2527
Practice Address - Country:US
Practice Address - Phone:610-543-5300
Practice Address - Fax:610-543-3124
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027134E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013981050003Medicaid
PA143269K9LMedicare PIN
PA110009918Medicare PIN