Healthcare Provider Details

I. General information

NPI: 1538485362
Provider Name (Legal Business Name): JULIETTE ANNE PRUST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 500
SILVER SPRING MD
20901-4463
US

IV. Provider business mailing address

10750 COLUMBIA PIKE STE 700
SILVER SPRING MD
20901-4461
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6772
  • Fax: 301-681-2773
Mailing address:
  • Phone: 804-517-9830
  • Fax: 301-681-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD007772
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: