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General NPI Number Information
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NPI Number | 1609867266
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Entity Type | Individual
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Provider Name | AARON J PRUSSIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 830 DAVIS ST SUITE 1
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City | BLACKSBURG
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State | VA
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Zip | 24060-7010
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Country | US
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Telephone | 540-381-0344
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Fax | 540-381-1462
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Provider Business Mailing Address
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Address Line | 127 S. 500 E SUITE 600
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1971
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Country | US
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Telephone | 801-587-6336
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Fax | 801-715-8228
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 0101051964
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | FP5290337
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License Number State | UT
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