Provider Demographics
NPI:1699789040
Name:NUSS, DONALD (MB, CHB)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:NUSS
Suffix:
Gender:M
Credentials:MB, CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDRENS SURGICAL SPECIALTY GROUP INC
Mailing Address - Street 2:PO BOX 631617
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1617
Mailing Address - Country:US
Mailing Address - Phone:757-668-7703
Mailing Address - Fax:757-668-8860
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:SUITE 5B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7703
Practice Address - Fax:757-668-8860
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010281322086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA35862OtherALLIANCE/MDIPA
VA15341OtherOPTIMA/SENTARA HEALTH
VA7906326OtherNORTH CAROLINA MEDICAID
VA35862OtherMAMSI/OPTIMUM CHOICE
VA4004787OtherAETNA
VA265053OtherANTHEM BCBS
VAB08242Medicare UPIN