Provider Demographics
NPI:1669517280
Name:BRUNER, DENISE E (MD FASBP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MD FASBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 N RIDGEVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:703-525-3344
Mailing Address - Fax:
Practice Address - Street 1:5015 LEE HIGHWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:703-558-4949
Practice Address - Fax:703-558-4980
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine