Healthcare Provider Details

I. General information

NPI: 1225616477
Provider Name (Legal Business Name): MATTHEW REVERE RUSLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MATTHEW RUSLING LAMEPTER DO

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PIDGEON HILL DR STE 230
STERLING VA
20165-6133
US

IV. Provider business mailing address

14 PIDGEON HILL DR STE 230
STERLING VA
20165-6133
US

V. Phone/Fax

Practice location:
  • Phone: 571-339-5435
  • Fax: 571-363-2253
Mailing address:
  • Phone: 571-339-5435
  • Fax: 571-363-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102207526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: