Healthcare Provider Details

I. General information

NPI: 1235456385
Provider Name (Legal Business Name): CHRISTOPHER R RUSSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STAFFORD ST # 154 / 101
SPRINGFIELD MA
01104-4110
US

IV. Provider business mailing address

2 MEDICAL CENTER DR # 410
SPRINGFIELD MA
01107-1270
US

V. Phone/Fax

Practice location:
  • Phone: 413-781-5735
  • Fax:
Mailing address:
  • Phone: 413-781-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number266233
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16325
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number266253
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: