Derusso, Patricia Ann
Derusso, Patricia Ann is an individual health care provider with primary practice located at 3401 Civic Center Blvd Children'S Hospital Of Phila - Gastro & Nutrition, Philadelphia PA 19104-4319. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Derusso, Patricia Ann can be contacted via phone (215) 590-3247.Contact Information
Primary practice address
3401 Civic Center Blvd Children'S Hospital Of Phila - Gastro & Nutrition
Philadelphia PA 19104-4319
Phone: (215) 590-3247
Fax: (215) 590-3606
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | R114248 | Maryland |
| Allopathic & Osteopathic Physicians / Pediatric Gastroenterology | 2080P0206X | MD048053L | Pennsylvania |
Profile Details
| NPI number | 1386689131 |
|---|---|
| LBN Legal business name | Derusso, Patricia Ann |
| Credentials | C.R.N.P. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2006 |
| Last updated | Apr 15th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386689131 | NPPES |
| Maryland | MEDICAID | 510050000 |
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