Basic Information
| Provider Information | |||||||||
| NPI: | 1609867266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRUSSIN | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 S. 500 E | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015876336 | ||||||||
| FaxNumber: | 8017158228 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 DAVIS ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BLACKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240607010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403810344 | ||||||||
| FaxNumber: | 5403811462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | 0101051964 | VA | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | 207Y00000X | FP5290337 | UT | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 006500111 | 01 | VA | VIRGINIA PREMIER | OTHER | 1000460 | 01 | VA | UNITED HEALTHCARE | OTHER | 018759S56 | 01 | VA | MEDICARE INDIVIDUAL PTAN | OTHER | 127380 | 01 | VA | SOUTHERN HEALTH | OTHER | A2283 | 01 | VA | MEDCOST | OTHER | C09521 | 01 | VA | MEDICARE GROUP PTAN | OTHER | 6566060005 | 01 | VA | CIGNA | OTHER | 541982275 | 01 | VA | JOHN DEERE | OTHER | 140176 | 01 | VA | ANTHEM | OTHER | C06556 | 01 | VA | MEDICARE GROUP PTAN | OTHER | 1609867266 | 05 | VA | MEDICAID | 332829 | 01 | VA | MAMSI | OTHER | 541982275 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 5860049 | 01 | VA | AETNA US HEALTHCARE | OTHER | C06637 | 01 | VA | MEDICARE GROUP # | OTHER | 006500111 | 05 | VA | MEDICAID | 140176 | 01 | VA | VIRGINIA HEALTHKEEPERS | OTHER |