Provider Demographics
NPI:1598041477
Name:ROBERT A. NUSSBAUM, MD, P.C.
Entity Type:Organization
Organization Name:ROBERT A. NUSSBAUM, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-313-8400
Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:STE 309
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3247
Mailing Address - Country:US
Mailing Address - Phone:703-313-8400
Mailing Address - Fax:703-313-9666
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:STE 309
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3247
Practice Address - Country:US
Practice Address - Phone:703-313-8400
Practice Address - Fax:703-313-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047887207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty