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General NPI Number Information
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NPI Number | 1386795326
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Entity Type | Individual
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Provider Name | RUSSELL J BERSCHEID M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 1218 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-6406
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Country | US
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Telephone | 931-540-4140
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Fax | 931-540-4143
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Provider Business Mailing Address
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Address Line | PO BOX 229
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City | WAKEFIELD
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State | RI
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Zip | 02880-0229
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Country | US
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Telephone | 401-788-8757
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28088
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License Number State | TN
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