MEDICARE: ROBERT S SHUSMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD027134E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609873991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT S SHUSMAN MD

Provider Business Mailing Address
First Line	:	450 PARK WAY
Second Line	:	SUITE 300
City	:	BROOMALL
State	:	PA
Zip	:	19008-4202
Country	:	US
Telephone Number	:	484-422-8080
Fax Number	:	484-422-8073

Provider Business Practice Location Address
First Line	:	9 N BROOKSIDE RD
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-2527
Country	:	US
Telephone Number	:	610-543-5300
Fax Number	:	610-543-3124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/16/2010

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