Provider Demographics
NPI:1689727349
Name:RUSHIN, AUDREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:M
Last Name:RUSHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CAMERON GLEN DR STE 500
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3343
Mailing Address - Country:US
Mailing Address - Phone:703-481-4100
Mailing Address - Fax:
Practice Address - Street 1:44075 PIPELINE PLZ STE 220
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5890
Practice Address - Country:US
Practice Address - Phone:703-554-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012354182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA299594OtherAMERIGROUP
VA4945247Medicaid
VA139522OtherBLUE CROSS BLUE SHIELD
VA299594OtherAMERIGROUP