Provider Demographics
NPI:1952348732
Name:DAVID B SHUSTER
Entity Type:Organization
Organization Name:DAVID B SHUSTER
Other - Org Name:DAVID B SHUSTER M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:SHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-643-1071
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:STE 309
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1602
Mailing Address - Country:US
Mailing Address - Phone:937-266-4668
Mailing Address - Fax:866-839-8449
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:STE 309
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45419-1602
Practice Address - Country:US
Practice Address - Phone:937-266-4668
Practice Address - Fax:866-839-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDASP05491Medicare PIN