Individual
PATRICIA ANN DERUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.P.
Contact information
Practice address
3401 CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILA - GASTRO & NUTRITION, PHILADELPHIA, PA 19104-4319
(215) 590-3247
(215) 590-3606
Mailing address
100 E PENN SQ, 9TH FLOOR, PHILADELPHIA, PA 19107-3323
(267) 425-9234
(267) 425-9299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R114248
MD
2080P0206X
Pediatric Gastroenterology Physician
Primary
MD048053L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510050000
—
MD
Enumeration date
06/17/2006
Last updated
04/15/2013
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