| Gregory Derusso Ltd | |
|
7505 Bustleton Ave Philadelphia PA 19152-4136 | |
| (215) 333-7505 | |
| (215) 333-8131 |
| Full Name | Gregory Derusso Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 7505 Bustleton Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Gregory Derusso (PRESIDENT) |
| Authorized Official Contact | 2153337505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory Derusso Ltd 7505 Bustleton Ave Philadelphia PA 19152-4136 Ph: (215) 333-7505 | Gregory Derusso Ltd 7505 Bustleton Ave Philadelphia PA 19152-4136 Ph: (215) 333-7505 |
| NPI Number | 1689724320 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2163522681 |
|---|---|
| Medicare Enrollment ID | O20070713000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689724320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gregory L Derusso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316959141 PECOS PAC ID: 9537100490 Enrollment ID: I20050520000417 |
| Provider Name | Peggy Anne Derusso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144860735 PECOS PAC ID: 6901227115 Enrollment ID: I20200526001506 |
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