MEDICARE: RUSSELL P. SENECA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	0101019015	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003802208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL P. SENECA M.D.

Provider Business Mailing Address
First Line	:	4001 FAIR RIDGE DR
Second Line	:	SUITE 304
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2917
Country	:	US
Telephone Number	:	703-359-8640
Fax Number	:	703-591-6105

Provider Business Practice Location Address
First Line	:	4001 FAIR RIDGE DR
Second Line	:	SUITE 304
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2917
Country	:	US
Telephone Number	:	703-359-8640
Fax Number	:	703-591-6105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	07/08/2007

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