Provider Demographics
NPI:1740273127
Name:RUST, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:RUST
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 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5728
Mailing Address - Fax:814-333-5726
Practice Address - Street 1:20 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-1319
Practice Address - Country:US
Practice Address - Phone:814-573-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052978-L174400000X
PA052978L207L00000X
PAMD052987L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1468809Medicaid
PA0014688090001Medicaid
PA0014688090001Medicaid
PAF84245Medicare UPIN