Provider Demographics
NPI:1619025632
Name:RUSH, VIVIAN CAROL (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:CAROL
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:CAROL
Other - Last Name:LICHTENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 PHILLIPS MILL RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2124
Mailing Address - Country:US
Mailing Address - Phone:410-436-7954
Mailing Address - Fax:410-436-4117
Practice Address - Street 1:USACHPPM
Practice Address - Street 2:MCHB-TS-MEM(RUSH)
Practice Address - City:APG
Practice Address - State:MD
Practice Address - Zip Code:21010-5422
Practice Address - Country:US
Practice Address - Phone:410-436-7954
Practice Address - Fax:410-436-4117
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00433352083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX332998YXZKMedicare PIN