Organization
PREMIER TRAUMA AND SURGICAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD VINCENT PUCCIO (PRESIDENT)
(610) 668-6495
Entity
Organization
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-6040
Mailing address
PO BOX 79295, BALTIMORE, MD 21279-0295
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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