Healthcare Provider Details

I. General information

NPI: 1568484954
Provider Name (Legal Business Name): DEBRA ZUSSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 WILMINGTON PIKE
GLEN MILLS PA
19342
US

IV. Provider business mailing address

1766 WILMINGTON PIKE
GLEN MILLS PA
19342
US

V. Phone/Fax

Practice location:
  • Phone: 610-358-2778
  • Fax: 610-358-3508
Mailing address:
  • Phone: 610-358-2778
  • Fax: 610-358-3508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-034058-E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0003002
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: