1982717583 NPI number — DR. MARK PUSCAS M.D.

Table of content: DR. MARK PUSCAS M.D. (NPI 1982717583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982717583 NPI number — DR. MARK PUSCAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUSCAS
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982717583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97303-0900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-399-2424
Provider Business Mailing Address Fax Number:
503-375-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 CAPITOL ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97301-0644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-399-2424
Provider Business Practice Location Address Fax Number:
503-375-7429
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD16639 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01778303 . This is a "RR MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: XPY199559 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106330 . This is a "WORK COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 076047 . This is a "MARION POLK CHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8188286 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS4159 . This is a "GROUP PTAN RR MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 076047 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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