Healthcare Provider Details

I. General information

NPI: 1679783609
Provider Name (Legal Business Name): LATONYA DEMETRIA RUSSELL MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATONYA DEMETRIA RUSSELL MESSERSCHMITT MD, MPH

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CAMELOT DR SUITE 200
VIRGINIA BEACH VA
23454-2440
US

IV. Provider business mailing address

1950 GLENN MITCHELL DR STE 310
VIRGINIA BEACH VA
23456-0019
US

V. Phone/Fax

Practice location:
  • Phone: 757-491-7337
  • Fax:
Mailing address:
  • Phone: 757-507-0402
  • Fax: 757-507-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101245930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: