Provider Demographics
NPI:1609867266
Name:PRUSSIN, AARON J (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:J
Last Name:PRUSSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S. 500 E
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1971
Mailing Address - Country:US
Mailing Address - Phone:801-587-6336
Mailing Address - Fax:801-715-8228
Practice Address - Street 1:830 DAVIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7010
Practice Address - Country:US
Practice Address - Phone:540-381-0344
Practice Address - Fax:540-381-1462
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051964207YX0007X
UTFP5290337207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006500111OtherVIRGINIA PREMIER
VA1000460OtherUNITED HEALTHCARE
VA018759S56OtherMEDICARE INDIVIDUAL PTAN
VA127380OtherSOUTHERN HEALTH
VAA2283OtherMEDCOST
VAC09521OtherMEDICARE GROUP PTAN
VA6566060005OtherCIGNA
VA541982275OtherJOHN DEERE
VA140176OtherANTHEM
VAC06556OtherMEDICARE GROUP PTAN
VA1609867266Medicaid
VA332829OtherMAMSI
VA541982275OtherVIRGINIA HEALTH NETWORK
VA5860049OtherAETNA US HEALTHCARE
VAC06637OtherMEDICARE GROUP #
VA006500111Medicaid
VA140176OtherVIRGINIA HEALTHKEEPERS
VA006500111Medicaid
VAVV2566AMedicare PIN
VAP00978057Medicare PIN
VA006500111OtherVIRGINIA PREMIER
VA040000482Medicare PIN