MEDICARE: DR. LARRY SHUSTERMAN D.O.

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	207Q00000X	Family Medicine Physician	OS-006113-L	PA
2	207R00000X	Internal Medicine Physician	OS-006113-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100326	OTHER	PA	KEYSTONE MERCY HEALTH PLA
2	0080977002	OTHER	PA	KEYSTONE HEALTH PLAN EAST
3	110127288	OTHER	PA	PALMETTO GBA
4	98583	OTHER	PA	US HEALTHCARE
5	4348882	OTHER	PA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	0114174702	OTHER	PA	AMERICHOICE
8	6724	OTHER	PA	ELDERHEALTH

General Provider Information

NPI Number	:	1831292614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY SHUSTERMAN D.O.

Provider Business Mailing Address
First Line	:	1600 S 28TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-1202
Country	:	US
Telephone Number	:	215-334-1166
Fax Number	:	215-336-1776

Provider Business Practice Location Address
First Line	:	1600 S 28TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-1202
Country	:	US
Telephone Number	:	215-334-1166
Fax Number	:	215-336-1776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	03/23/2016

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