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General NPI Number Information
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NPI Number | 1568626208
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY BRUSCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 3120 FAIRVIEW PARK DR STE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22042-4570
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Country | US
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Telephone | 571-755-2020
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Fax | 276-209-5733
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Provider Business Mailing Address
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Address Line | 3120 FAIRVIEW PARK DR STE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22042-4570
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Country | US
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Telephone | 571-755-2020
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Fax | 276-209-5733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101258561
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License Number State | VA
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