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General NPI Number Information
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NPI Number | 1184691222
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Entity Type | Individual
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Provider Name | MARY LOUISE RUSSELL MD
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 1405 SHADY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15217-1350
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Country | US
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Telephone | 412-420-2270
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Fax | 412-420-4450
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER DR P.O.BOX 9196
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City | MORGANTOWN
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State | WV
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Zip | 26506-1200
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Country | US
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Telephone | 304-293-3909
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Fax | 304-293-7042
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD044119E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD044119E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 29378
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License Number State | WV
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