Provider Demographics
NPI:1851518393
Name:RUSEVLYAN, AINSLEY ROBERSON (DPM)
Entity Type:Individual
Prefix:DR
First Name:AINSLEY
Middle Name:ROBERSON
Last Name:RUSEVLYAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3841
Mailing Address - Country:US
Mailing Address - Phone:252-946-1181
Mailing Address - Fax:252-946-2309
Practice Address - Street 1:114 AVON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3841
Practice Address - Country:US
Practice Address - Phone:252-946-1181
Practice Address - Fax:252-946-2309
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC518213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6133110001Medicare NSC