Provider Demographics
NPI:1730281924
Name:RUSCETTI, HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:RUSCETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BRIDGE BARRIER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-3939
Mailing Address - Country:US
Mailing Address - Phone:910-458-4101
Mailing Address - Fax:910-458-5617
Practice Address - Street 1:1300 BRIDGE BARRIER RD STE 2
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3939
Practice Address - Country:US
Practice Address - Phone:910-458-4101
Practice Address - Fax:910-458-5617
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913085Medicaid
NC080186041OtherRAILROAD MEDICARE
NC13085OtherBCBS NC
NC8913085Medicaid
NC2002532BMedicare PIN
NC13085OtherBCBS NC
NC2002532Medicare PIN