Provider Demographics
NPI:1235193533
Name:RUSH, KAREN D (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:D
Other - Last Name:WILSON-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2897 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1799
Mailing Address - Country:US
Mailing Address - Phone:757-484-7248
Mailing Address - Fax:757-484-8316
Practice Address - Street 1:2897 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1799
Practice Address - Country:US
Practice Address - Phone:757-484-7248
Practice Address - Fax:757-484-8316
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5626293Medicaid
VA5626293Medicaid
VAH00798Medicare UPIN
VA080177181Medicare PIN