Healthcare Provider Details

I. General information

NPI: 1558629881
Provider Name (Legal Business Name): CAITLIN R RUSSELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 MCCLELLAN ST STE 101
SCHENECTADY NY
12304-1020
US

IV. Provider business mailing address

624 MCCLELLAN ST STE 101
SCHENECTADY NY
12304-1020
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-2260
  • Fax: 518-347-5007
Mailing address:
  • Phone: 518-382-2260
  • Fax: 518-347-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346036
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: