MEDICARE: DR. RONALD PRUSSICK M.D.

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	174400000X	Specialist	D0041493	MD

General Provider Information

NPI Number	:	1588647085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD PRUSSICK M.D.

Provider Business Mailing Address
First Line	:	6163 EXECUTIVE BLVD
Second Line	:
City	:	N BETHESDA
State	:	MD
Zip	:	20852-3901
Country	:	US
Telephone Number	:	301-984-3000
Fax Number	:	301-984-3001

Provider Business Practice Location Address
First Line	:	6163 EXECUTIVE BLVD
Second Line	:
City	:	N BETHESDA
State	:	MD
Zip	:	20852-3901
Country	:	US
Telephone Number	:	301-984-3000
Fax Number	:	301-984-3001

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/23/2010

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