Provider Demographics
NPI:1427053776
Name:BUSCHER, BETH A (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BUSCHER
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 1:170 MOUNT PLEASANT RD
Mailing Address - Street 2:STE 201
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1408
Mailing Address - Country:US
Mailing Address - Phone:203-792-4151
Mailing Address - Fax:203-792-4155
Practice Address - Street 1:170 MOUNT PLEASANT RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1408
Practice Address - Country:US
Practice Address - Phone:203-792-4151
Practice Address - Fax:203-792-4155
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041257207N00000X
NY198757-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001412577Medicaid
CTG48316Medicare UPIN
CT001412577Medicaid