Healthcare Provider Details

I. General information

NPI: 1992848683
Provider Name (Legal Business Name): SYBIL A RUSSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYBIL ANN KLAUS

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST ROOM 9411
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 808-780-5430
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME97556
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME97556
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME97556
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD67183
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: