Provider Demographics
NPI:1770507337
Name:BUSCH, SCOTT L (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1797 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2136
Mailing Address - Country:US
Mailing Address - Phone:856-424-0414
Mailing Address - Fax:856-424-6335
Practice Address - Street 1:1797 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2136
Practice Address - Country:US
Practice Address - Phone:856-424-0414
Practice Address - Fax:855-863-9361
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB03778600207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3392406Medicaid
NJ3392406Medicaid