Provider Demographics
NPI:1255316485
Name:HURST, DENISE L (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:HURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6153 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2541
Mailing Address - Country:US
Mailing Address - Phone:703-342-4688
Mailing Address - Fax:703-924-1114
Practice Address - Street 1:6153 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310
Practice Address - Country:US
Practice Address - Phone:703-342-4688
Practice Address - Fax:703-924-1114
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052323207R00000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI004604130Medicare PIN
VA008090V81Medicare ID - Type Unspecified
VAG26599Medicare UPIN