Healthcare Provider Details

I. General information

NPI: 1265377329
Provider Name (Legal Business Name): MICHAEL WILLIAM RUSSELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HAWK RIDGE DR
HAMBURG PA
19526-9219
US

IV. Provider business mailing address

700 HAWK RIDGE DR
HAMBURG PA
19526-9219
US

V. Phone/Fax

Practice location:
  • Phone: 610-562-3066
  • Fax: 610-562-3125
Mailing address:
  • Phone: 610-562-3066
  • Fax: 610-562-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT025071
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: