Provider Demographics
NPI:1952691545
Name:HORACIO BUSCHIAZZO M D LLC
Entity Type:Organization
Organization Name:HORACIO BUSCHIAZZO M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:HORACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHIAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-831-8319
Mailing Address - Street 1:4955 FRANKFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124
Mailing Address - Country:US
Mailing Address - Phone:215-831-8319
Mailing Address - Fax:215-744-2419
Practice Address - Street 1:4955 FRANKFORD AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-831-8319
Practice Address - Fax:215-744-2419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORACIO BUSCHIAZZO M D LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-15
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033769L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB36820Medicare UPIN
PA110093Medicare PIN