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General NPI Number Information
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NPI Number | 1669704508
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Entity Type | Organization
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Legal Business Name | WILLIAM RUSSELL MD PA
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 600 VIRGINIA AVE STE 2
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City | CUMBERLAND
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State | MD
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Zip | 21502-4551
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Country | US
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Telephone | 301-723-4380
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Fax | 301-723-4812
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Provider Business Mailing Address
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Address Line | 600 VIRGINIA AVE STE 2 PO BOX 1726
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City | CUMBERLAND
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State | MD
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Zip | 21502-4551
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Country | US
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Telephone | 301-723-4380
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Fax | 301-723-4812
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. WILLIAM RUSSELL
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Credential | M.D.
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Telephone | 301-723-4380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | D0050636
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License Number State | MD
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