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General NPI Number Information
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NPI Number | 1174863864
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Entity Type | Individual
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Provider Name | ROUSLAN TOURTSEV D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/18/2013
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 193 OLD SWEDE RD
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-1522
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Country | US
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Telephone | 610-385-3010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 287
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City | AINSWORTH
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State | NE
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Zip | 69210-0287
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Country | US
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Telephone | 402-387-1900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT014999
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1504
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS020544
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License Number State | PA
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