Organization
DR. JEANVICKEY LUSK, M.D. & CO. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANVICKEY LUSK, M.D. M.D. (OWNER)
(215) 200-8447
Entity
Organization
Contact information
Practice address
315 GYPSY LANE, KING OF PRUSSIA, PA 19406
(215) 200-8447
Mailing address
P.O. BOX 60940, KING OF PRUSSIA, PA 19406
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5800
AL
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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