Healthcare Provider Details

I. General information

NPI: 1770529935
Provider Name (Legal Business Name): SCOTT ALLEN RUSHTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE STE 280
WYNNEWOOD PA
19096
US

IV. Provider business mailing address

100 E LANCASTER AVE STE 280
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-3005
  • Fax: 610-649-4367
Mailing address:
  • Phone: 610-642-3005
  • Fax: 610-649-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD056594L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberC10007827
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA07199900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: