Provider Demographics
NPI:1982627071
Name:BUSUTTIL, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BUSUTTIL
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 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-6454
Mailing Address - Fax:
Practice Address - Street 1:25 MONUMENT RD STE 145
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-851-6454
Practice Address - Fax:717-851-1665
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059723208600000X
NC2009016182086S0129X
VA0101250512086S0129X
PABB42876182086S0129X
PAMD052677L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102986697Medicaid
VA1982627071Medicaid
MD402453200Medicaid
MDP00104475Medicaid
DE0000471501Medicaid
MD0048OtherCAREFIRST
MD112716OtherUS HEALTHCARE
MD17742OtherFREESTATE
MD217054OtherMDIPA
MD214337OtherKAISER
MD53089OtherGEISINGER PROVIDER
PA1232082/01Medicaid
MD1700826OtherUNITED HLTHCARE
MD52248703OtherBLUE SHIELD
NJ8798401Medicaid
PA102986697Medicaid
MDG446Medicare PIN