=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538485362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIETTE ANNE PRUST M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2010
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10750 COLUMBIA PIKE STE 500
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-681-6772
-----------------------------------------------------
Fax | 301-681-2773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10750 COLUMBIA PIKE STE 700
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-4461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-517-9830
-----------------------------------------------------
Fax | 301-681-2773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D007772
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------