Provider Demographics
NPI:1215907233
Name:RUSCHEINSKY, DELTA D (MD)
Entity type:Individual
Prefix:DR
First Name:DELTA
Middle Name:D
Last Name:RUSCHEINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 TRANCAS ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2942
Mailing Address - Country:US
Mailing Address - Phone:707-252-4961
Mailing Address - Fax:707-252-4964
Practice Address - Street 1:935 TRANCAS ST STE 1A
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2942
Practice Address - Country:US
Practice Address - Phone:707-252-4961
Practice Address - Fax:707-252-4964
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24599207Q00000X
CAC55329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277320Medicaid
ORR136992Medicare PIN
OR277320Medicaid