=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952691545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORACIO BUSCHIAZZO M D LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2011
-----------------------------------------------------
Last Update Date | 04/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4955 FRANKFORD AVENUE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-831-8319
-----------------------------------------------------
Fax | 215-744-2419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4955 FRANKFORD AVENUE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-831-8319
-----------------------------------------------------
Fax | 215-744-2419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERNAL MEDICINE
-----------------------------------------------------
Name | DR. HORACIO BUSCHIAZZO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 215-831-8319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD033769L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------