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General NPI Number Information
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NPI Number | 1336225994
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Entity Type | Individual
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Provider Name | JOSEPH M RUSSO DPM
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 9712 BELAIR RD STE LL3
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1110
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Country | US
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Telephone | 410-256-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 1 NORTH MAIN STREET
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City | BEL AIR
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State | MD
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Zip | 21014
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Country | US
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Telephone | 410-803-0788
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Fax | 410-803-1859
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 01096
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License Number State | MD
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