MEDICARE: DR. PAUL ANDREW RUSONIS M.D.

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	207N00000X	Dermatology Physician	D0030058	MD

General Provider Information

NPI Number	:	1922077171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ANDREW RUSONIS M.D.

Provider Business Mailing Address
First Line	:	6021 UNIVERSITY BLVD
Second Line	:	SUITE 390
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6077
Country	:	US
Telephone Number	:	410-203-0607
Fax Number	:	410-203-0677

Provider Business Practice Location Address
First Line	:	6021 UNIVERSITY BLVD
Second Line	:	SUITE 390
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6077
Country	:	US
Telephone Number	:	410-203-0607
Fax Number	:	410-203-0677

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	10/24/2011

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