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General NPI Number Information
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NPI Number | 1053607705
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Entity Type | Individual
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Provider Name | CHRISTOPHER J RUSSO MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 1001 S GEORGE ST STE 130
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City | YORK
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State | PA
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Zip | 17403-3676
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Country | US
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Telephone | 717-851-3884
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Fax |
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Provider Business Mailing Address
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Address Line | 1119 LEMON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-2525
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD470084
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT041849T
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License Number State | PA
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