Provider Demographics
NPI:1922023993
Name:RUSH, PHILIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:RUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1844 SAN MIGUEL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4963
Mailing Address - Country:US
Mailing Address - Phone:925-937-6000
Mailing Address - Fax:925-937-2823
Practice Address - Street 1:1844 SAN MIGUEL DR STE 310
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4963
Practice Address - Country:US
Practice Address - Phone:925-937-6000
Practice Address - Fax:925-937-2823
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28043208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G280430Medicaid
CA370008905Medicare PIN
CA00G28043Medicare PIN
CA00G280430Medicaid