Provider Demographics
NPI:1316081284
Name:DENISE E BRUNER MD & ASSOC PC
Entity type:Organization
Organization Name:DENISE E BRUNER MD & ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FASBP
Authorized Official - Phone:703-558-4949
Mailing Address - Street 1:5015 LEE HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:703-558-4949
Mailing Address - Fax:703-558-4980
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty