Provider Demographics
NPI:1932171501
Name:BRUSSE, DAWN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:BRUSSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:80 WYNTRE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4535
Mailing Address - Country:US
Mailing Address - Phone:717-741-9462
Mailing Address - Fax:717-741-4399
Practice Address - Street 1:80 WYNTRE BROOKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4535
Practice Address - Country:US
Practice Address - Phone:717-741-9462
Practice Address - Fax:717-741-4399
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071349L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA606644OtherHIGHMARK BLUE SHIELD
PA001874521001Medicaid
PW136324OtherHEALTH AMERICA
PW1520948OtherGATEWAY HEALTH PLAN
PW02377500OtherCAPITAL BLUE CROSS
PA039640PL6Medicare ID - Type UnspecifiedMEDICARE
PA001874521001Medicaid