Provider Demographics
NPI:1326619669
Name:RUGARBER, MARK RICHARD (FNP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:RUGARBER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW.
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:
Practice Address - Street 1:205 E. HIRST ROAD, SUITE 203
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6602
Practice Address - Country:US
Practice Address - Phone:540-751-0255
Practice Address - Fax:540-751-0466
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF06211748363LF0000X
VA0024187734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326619669Medicaid
VA30015421980002Medicaid