Healthcare Provider Details

I. General information

NPI: 1467744615
Provider Name (Legal Business Name): ERICA C RUSHING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 WEST CHESTER PIKE BLDG D, SUITE 120
NEWTOWN SQUARE PA
19073-2304
US

IV. Provider business mailing address

14275 MIDWAY ROAD SUITE 400
ADDISON TX
75001-3676
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-0117
  • Fax: 610-550-3079
Mailing address:
  • Phone: 800-257-0117
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD441580
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number2012-00971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: