Provider Demographics
NPI:1720006018
Name:SHUSTERMAN, DENISE K (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:SHUSTERMAN
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 1:26 BRYAN DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-2000
Mailing Address - Country:US
Mailing Address - Phone:215-355-2844
Mailing Address - Fax:215-355-6164
Practice Address - Street 1:250 CETRONIA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9147
Practice Address - Country:US
Practice Address - Phone:610-366-0444
Practice Address - Fax:610-366-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037079-E207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF04337Medicare UPIN