Provider Demographics
NPI:1275694028
Name:PRUSS, MARIO EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:EDUARDO
Last Name:PRUSS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:505 SKIDMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1201
Mailing Address - Country:US
Mailing Address - Phone:708-677-2232
Mailing Address - Fax:301-576-7152
Practice Address - Street 1:966 HUNGERFORD DR STE 20A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1741
Practice Address - Country:US
Practice Address - Phone:708-677-2232
Practice Address - Fax:301-576-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045248251S00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB46448Medicare UPIN