Provider Demographics
NPI:1780645523
Name:LUSCH, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:LUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 16052
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:610-374-4404
Mailing Address - Fax:610-374-1396
Practice Address - Street 1:S 6TH AVE & SPRUCE ST
Practice Address - Street 2:TRHMC REGIONAL CANCER CENTER N GROUND
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-374-4404
Practice Address - Fax:610-374-1396
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD006507E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110039794OtherRAILROAD MEDICARE
20015345OtherAMERIHEALTH MERCY
PA017955OtherHIGHMARK BLUE SHIELD
PA0006470550001Medicaid
87786OtherUNISON
PA01385901OtherCAPITAL BLUE CROSS
20015345OtherAMERIHEALTH MERCY
PA017955D7GMedicare ID - Type Unspecified