Provider Demographics
NPI:1821053760
Name:LUSCHE, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:LUSCHE
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 1:3320 SKYWAY DR
Mailing Address - Street 2:SUITE 801
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7137
Mailing Address - Country:US
Mailing Address - Phone:334-821-0238
Mailing Address - Fax:334-821-6685
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:SUITE 801
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-821-0238
Practice Address - Fax:334-821-6685
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23180101YM0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529905580OtherALABAMA MEDICAID GROUP #
AL510-98477OtherBLUE CROSS OF AL PROVIDER
AL009936990Medicaid
AL009936990Medicaid
AL000098477LUSMedicare ID - Type UnspecifiedPROVIDER #