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Individual

DR. MICHAEL CUSICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD, MHSA

Contact information

Practice address
1300 JEFFERSON PARK AVE, CHARLOTTESVILLE, VA 22903-3363
(434) 924-5485
(434) 244-9436
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
0101269475
VA
207W00000X
Ophthalmology Physician
MD-439428
PA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
0101269475
VA
207WX0107X
Retina Specialist (Ophthalmology) Physician
MD-439428
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102474527
PA
Enumeration date
01/31/2007
Last updated
08/09/2023
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