Healthcare Provider Details

I. General information

NPI: 1285645200
Provider Name (Legal Business Name): LOUIS RUSSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1725
  • Fax: 603-227-7557
Mailing address:
  • Phone: 603-224-1725
  • Fax: 603-227-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101263233
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number014997
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD050220L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number20944
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: