Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2305208044 | VA |
Y | 213ES0000X | Sports Medicine | 2305208044 | VA |
NPI | 1487307864 |
---|---|
Provider Name | Justin Trumbull |
First Address | Arlington, VA 22205-3610 |
Second Address | Arlington, VA 22205-3610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2022 |
Last Update Date | 27/01/2022 |