MEDICARE: DR. DENNIS M RUSTOM M.D., F.A.A.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101054293	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497720361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS M RUSTOM M.D., F.A.A.P.

Provider Business Mailing Address
First Line	:	20 ROCK POINTE LN
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-2679
Country	:	US
Telephone Number	:	540-347-9900
Fax Number	:	540-349-0920

Provider Business Practice Location Address
First Line	:	20 ROCK POINTE LN
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-2679
Country	:	US
Telephone Number	:	540-347-9900
Fax Number	:	540-349-0920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/04/2011

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