Healthcare Provider Details

I. General information

NPI: 1275694028
Provider Name (Legal Business Name): MARIO EDUARDO PRUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 HUNGERFORD DR STE 20A
ROCKVILLE MD
20850-1741
US

IV. Provider business mailing address

505 SKIDMORE BLVD
GAITHERSBURG MD
20877-1201
US

V. Phone/Fax

Practice location:
  • Phone: 708-677-2232
  • Fax: 301-576-7152
Mailing address:
  • Phone: 708-677-2232
  • Fax: 301-576-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0045248
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberD0045248
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: