Provider Demographics
NPI:1598815060
Name:LUSTER, CHRISTOPHER ADAM (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ADAM
Last Name:LUSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:601 POTOMAC STATION DR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1816
Practice Address - Country:US
Practice Address - Phone:703-840-1396
Practice Address - Fax:703-840-1397
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA328140YWAU - 321847Medicare PIN
VAVV4652A - C03895Medicare PIN