Provider Demographics
NPI:1952353195
Name:RUST, HARLAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:C
Last Name:RUST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6160 KEMPSVILLE CIRCLE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-466-9288
Mailing Address - Fax:757-457-3691
Practice Address - Street 1:400 GRESHAM DR
Practice Address - Street 2:907 MEDICAL TOWER
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1901
Practice Address - Country:US
Practice Address - Phone:757-627-7301
Practice Address - Fax:757-627-6238
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-24
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Provider Licenses
StateLicense IDTaxonomies
VA0101239272207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00360163OtherRAILROAD MEDICARE
010029N50Medicare PIN
VAP00360163OtherRAILROAD MEDICARE