Provider Demographics
NPI:1528039260
Name:BRUST, STUART W (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:W
Last Name:BRUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-847-1095
Mailing Address - Fax:434-847-1096
Practice Address - Street 1:2323 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-847-1095
Practice Address - Fax:434-847-1096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023792207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA276975OtherSOUTHERN HEALTH
VA064317OtherANTHEM
VA064317OtherANTHEM