Provider Demographics
NPI:1356376644
Name:DUSHUTTLE, RICHARD P (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:DUSHUTTLE
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 1:240 BEISER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7790
Mailing Address - Country:US
Mailing Address - Phone:302-678-4513
Mailing Address - Fax:302-678-3193
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7790
Practice Address - Country:US
Practice Address - Phone:302-678-4513
Practice Address - Fax:302-678-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000101901Medicaid
DE0000134402Medicaid
DE0000134402Medicaid
DE607899Medicare ID - Type UnspecifiedGROUP
DEB66561Medicare UPIN