Individual
DR. GREGORY LOUIS DERUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7505 BUSTLETON AVE, PHILADELPHIA, PA 19152-4136
(215) 333-7505
(215) 333-8131
Mailing address
7505 BUSTLETON AVE, PHILADELPHIA, PA 19152-4136
(215) 333-7505
(215) 333-8131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD062841L
PA
Other
Enumeration date
08/12/2006
Last updated
07/08/2007
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