Healthcare Provider Details

I. General information

NPI: 1710818984
Provider Name (Legal Business Name): ANNA MATTEA RUSSO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

IV. Provider business mailing address

211 LANCASTER DR
AGAWAM MA
01001-2287
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5700
  • Fax:
Mailing address:
  • Phone: 413-519-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: