Provider Demographics
NPI:1194770453
Name:SHUSTER, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2312 FAR HILLS AVE
Mailing Address - Street 2:#349
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1512
Mailing Address - Country:US
Mailing Address - Phone:937-266-4668
Mailing Address - Fax:866-839-8449
Practice Address - Street 1:580 LINCOLN PARK BLVD STE 255
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3493
Practice Address - Country:US
Practice Address - Phone:937-266-4668
Practice Address - Fax:866-839-8449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9855-S2081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0805203Medicaid
OH0805203Medicaid
OH0675562Medicare PIN
OHSP05491Medicare PIN
OHBS2332081OtherDEA