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General NPI Number Information
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NPI Number | 1649739541
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Entity Type | Individual
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Provider Name | JAMES RYAN RUSSELL MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 10710 CHARTER DR STE 130
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City | COLUMBIA
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State | MD
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Zip | 21044-3258
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Country | US
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Telephone | 410-772-7000
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Fax | 410-772-7072
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Provider Business Mailing Address
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Address Line | 10710 CHARTER DR STE 130
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City | COLUMBIA
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State | MD
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Zip | 21044-3258
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Country | US
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Telephone | 410-772-7000
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | D0102480
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 25MA12135100
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License Number State | NJ
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