MEDICARE: RUSSELL GEORGE VASILE 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	2084P0800X	Psychiatry Physician	38250	MA

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	:	1083707962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL GEORGE VASILE M.D.

Provider Business Mailing Address
First Line	:	330 BROOKLINE AVE
Second Line	:	RABB 2
City	:	BOSTON
State	:	MA
Zip	:	02215-5400
Country	:	US
Telephone Number	:	617-667-4738
Fax Number	:	617-975-5274

Provider Business Practice Location Address
First Line	:	25 BAY STATE RD
Second Line	:	SUITE ONE
City	:	BOSTON
State	:	MA
Zip	:	02215-2108
Country	:	US
Telephone Number	:	617-437-9566
Fax Number	:	617-975-5274

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/16/2011

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