Provider Demographics
NPI:1629334982
Name:BUSHMAN, ELISA THELYS (MD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:THELYS
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE GR59
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-3951
Mailing Address - Fax:412-578-1587
Practice Address - Street 1:4815 LIBERTY AVE STE GR59
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-3951
Practice Address - Fax:412-578-1587
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473449207VM0101X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine