MEDICARE: AR MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD436215	PA
2	207Q00000X	Family Medicine Physician	MD436215	PA

General Provider Information

NPI Number	:	1780987610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AR MEDICAL PC

Provider Business Mailing Address
First Line	:	1212 VETERANS HWY
Second Line	:	SUITE A-1 BOX 845
City	:	BRISTOL
State	:	PA
Zip	:	19007-2512
Country	:	US
Telephone Number	:	732-306-1724
Fax Number	:	267-535-2757

Provider Business Practice Location Address
First Line	:	6100 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3224
Country	:	US
Telephone Number	:	732-306-1724
Fax Number	:	267-535-2757

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/PRESIDENT
Name	:	ALEXANDER RUSANOV
Credential	:	M.D.
Telephone Number	:	732-306-1724

Provider Enumeration Date	:	12/15/2010
Last Update Date	:	12/15/2010

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Directions to “AR MEDICAL PC ” Practice Location

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