Provider Demographics
NPI:1932952876
Name:TSKITISHVILI, RUSUDAN
Entity Type:Individual
Prefix:
First Name:RUSUDAN
Middle Name:
Last Name:TSKITISHVILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HADDON AVENUE
Mailing Address - Street 2:VIRTUA OUR LADY OF LOURDES HOSPITAL, GRADUATE MEDICAL E
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-757-3500
Mailing Address - Fax:
Practice Address - Street 1:1600 HADDON AVENUE
Practice Address - Street 2:VIRTUA OUR LADY OF LOURDES HOSPITAL, GRADUATE MEDICAL E
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-757-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program