Healthcare Provider Details

I. General information

NPI: 1225561509
Provider Name (Legal Business Name): RONALD CHARLES RUSSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 BALLTOWN RD STE 300
SCHENECTADY NY
12309-1079
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-8184
  • Fax: 518-370-5143
Mailing address:
  • Phone: 518-525-5601
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number306683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: