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General NPI Number Information
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NPI Number | 1699207118
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Entity Type | Individual
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Provider Name | CHELSEY RUSS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 491 GOLD STAR HWY STE 100
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City | GROTON
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State | CT
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Zip | 06340-6226
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Country | US
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Telephone | 860-445-4290
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Fax | 860-448-1368
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Provider Business Mailing Address
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Address Line | 5 LAWRENCE ST UNIT 624
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4671
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 067559
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License Number State | CT
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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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