Provider Demographics
NPI:1003897596
Name:RUSCHAK, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:RUSCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 STOOPS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063
Mailing Address - Country:US
Mailing Address - Phone:724-483-5507
Mailing Address - Fax:724-483-0530
Practice Address - Street 1:100 STOOPS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063
Practice Address - Country:US
Practice Address - Phone:724-483-5507
Practice Address - Fax:724-483-0530
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAR2727280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA073226OtherHIGHMARK BC/BS
PA070014620OtherPALMETTO GBA/RAILROAD MED
PA070014620OtherPALMETTO GBA/RAILROAD MED
PA128758UQ4Medicare PIN