Provider Demographics
NPI:1407049265
Name:PRUNA, CHUCK G (DO)
Entity Type:Individual
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First Name:CHUCK
Middle Name:G
Last Name:PRUNA
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Gender:M
Credentials:DO
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Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 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:703-443-8643
Practice Address - Street 1:19415 DEERFIELD AVENUE, SUITE 112
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8470
Practice Address - Country:US
Practice Address - Phone:703-724-1195
Practice Address - Fax:703-724-4495
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2024-03-18
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Provider Licenses
StateLicense IDTaxonomies
VA0102203292208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407049265Medicaid
VA30016803970001Medicaid
VA0102203292Medicaid