Healthcare Provider Details

I. General information

NPI: 1356398234
Provider Name (Legal Business Name): KAMAL B. RUSSELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

IV. Provider business mailing address

1068 W BALTIMORE PIKE
MEDIA PA
19063-5104
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-3388
  • Fax: 310-891-3680
Mailing address:
  • Phone: 610-891-3388
  • Fax: 310-891-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMAL B. RUSSELL
Title or Position: PRESIDENT
Credential: MD
Phone: 610-891-3388