Healthcare Provider Details

I. General information

NPI: 1477548394
Provider Name (Legal Business Name): RUSSELL ALAN BLINDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

44 BINNEY ST RADIOLOGY, DANA-FARBER CANCER INSTITUTE
BOSTON MA
02115-6013
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3306
  • Fax: 617-632-5579
Mailing address:
  • Phone: 617-632-3306
  • Fax: 617-632-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number159471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: