Healthcare Provider Details

I. General information

NPI: 1851550495
Provider Name (Legal Business Name): ADAM TERRENCE CHRUSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 TOWNSHIP LINE RD STE 110
BLUE BELL PA
19422-2721
US

IV. Provider business mailing address

833 CHESTNUT ST STE 520
PHILADELPHIA PA
19107-4430
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax: 267-479-1321
Mailing address:
  • Phone: 800-321-9999
  • Fax: 267-339-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME153117
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD432526
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: