Healthcare Provider Details

I. General information

NPI: 1679583587
Provider Name (Legal Business Name): RUSSELL OWEN SCHUB D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8875 CENTRE PARK DR SUITE D
COLUMBIA MD
21045-2114
US

IV. Provider business mailing address

8875 CENTRE PARK DR SUITE D
COLUMBIA MD
21045-2114
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-1000
  • Fax: 410-730-8615
Mailing address:
  • Phone: 410-730-1000
  • Fax: 410-730-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberH35058
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: