Basic Information
| Provider Information | |||||||||
| NPI: | 1295792455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUSHNER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 CANDLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | UPPER ST CLAIR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152412907 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1050 BOWER HILL RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125726122 | ||||||||
| FaxNumber: | 4125610318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 04/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD-046207L | PA | N | Other Service Providers | Specialist | 207R00000X | MD046207L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110136230 | 01 | RAILROAD MEDICARE PTAN | OTHER | 0012899980004 | 05 | PA | MEDICAID | 0012899980005 | 05 | PA | MEDICAID |