Healthcare Provider Details

I. General information

NPI: 1245272376
Provider Name (Legal Business Name): RUSSELL C SAWYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 PARK RIDGE DR
CROZET VA
22932
US

IV. Provider business mailing address

PO BOX 79777
BALTIMORE MD
21279-0777
US

V. Phone/Fax

Practice location:
  • Phone: 434-823-4567
  • Fax: 434-823-4272
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-823-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101045650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: