Healthcare Provider Details

I. General information

NPI: 1336300672
Provider Name (Legal Business Name): RUSSELL SCOTT TRAISTER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 154
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

MEDICAL CENTER BLVD SUITE N713
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-578-4003
  • Fax: 412-578-4011
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number201600100
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT193164
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMT193164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: