Provider Demographics
NPI:1609922475
Name:RUSH, THERESA A (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 NORTH FOREST RD.
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-639-4034
Mailing Address - Fax:716-929-8940
Practice Address - Street 1:2240 NORTH FOREST RD.
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-639-4034
Practice Address - Fax:716-929-8940
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194217207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01488297Medicaid
NY0706211OtherIHA
NY00010152301OtherUNIVERA
NY000523332001OtherBCBS
NY00010152301OtherUNIVERA
NY01488297Medicaid