MEDICARE: MATTHEW REVERE RUSLING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0102207526	VA

General Provider Information

NPI Number	:	1225616477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW REVERE RUSLING

Provider Business Mailing Address
First Line	:	PO BOX 2320
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-0320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2320
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-0320
Country	:	US
Telephone Number	:	202-596-1465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/02/2026

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