Healthcare Provider Details

I. General information

NPI: 1861573131
Provider Name (Legal Business Name): RUSSELL R HILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11804 LISBOROUGH ROAD
BOWIE MD
20720
US

IV. Provider business mailing address

11804 LISBOROUGH ROAD
BOWIE MD
20720
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-4181
  • Fax: 301-262-4181
Mailing address:
  • Phone: 301-262-4181
  • Fax: 301-262-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD12039
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: