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General NPI Number Information
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NPI Number | 1205148707
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Entity Type | Individual
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Provider Name | JONATHON O RUSSELL MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 7226 LEE DEFOREST DR STE 204
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City | COLUMBIA
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State | MD
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Zip | 21046-3238
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Country | US
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Telephone | 443-333-5233
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Fax | 443-333-5232
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Provider Business Mailing Address
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Address Line | 7226 LEE DEFOREST DR STE 204
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City | COLUMBIA
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State | MD
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Zip | 21046-3238
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Country | US
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Telephone | 443-333-5233
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Fax | 443-333-5232
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | D0079238
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | AC2895437L2
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License Number State | OH
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