Provider Demographics
NPI:1023091501
Name:BUSCH, CALVERT RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:CALVERT
Middle Name:RAYMOND
Last Name:BUSCH
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 1:1380 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4926
Mailing Address - Country:US
Mailing Address - Phone:937-293-3486
Mailing Address - Fax:937-293-3605
Practice Address - Street 1:1380 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4926
Practice Address - Country:US
Practice Address - Phone:937-293-3486
Practice Address - Fax:937-293-3605
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043378207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000039027OtherANTHEM
OH2153717OtherAETNA
OH0398181Medicaid
OH060053779OtherRR MEDICARE
OH2501766OtherUNITED HEALTHCARE
OH000000039027OtherANTHEM
OH2153717OtherAETNA