Provider Demographics
NPI:1851042931
Name:RUSCHMAN, DOMINIC EDWARD
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:EDWARD
Last Name:RUSCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MOOCK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:KY
Mailing Address - Zip Code:41071-5465
Mailing Address - Country:US
Mailing Address - Phone:859-341-9333
Mailing Address - Fax:
Practice Address - Street 1:1 MOOCK RD STE 101
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071-5465
Practice Address - Country:US
Practice Address - Phone:859-341-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program