Healthcare Provider Details

I. General information

NPI: 1245483684
Provider Name (Legal Business Name): DENISE L. HURST, MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6153 FULLER CT
ALEXANDRIA VA
22310-2541
US

IV. Provider business mailing address

6153 FULLER CT
ALEXANDRIA VA
22310-2541
US

V. Phone/Fax

Practice location:
  • Phone: 703-342-4688
  • Fax: 703-924-1114
Mailing address:
  • Phone: 703-342-4688
  • Fax: 703-924-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE HURST
Title or Position: OWNER
Credential: MD
Phone: 703-342-4688