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NPI Code Detail

MEDICARE: DR. MARY LOUISE RUSSELL MD

MEDICARE: DR. MARY LOUISE RUSSELL MD
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
1208000000XPediatrics PhysicianMD044119EPA
2208100000XPhysical Medicine & Rehabilitation PhysicianMD044119EPA
3208100000XPhysical Medicine & Rehabilitation Physician29378WV

Other Identifiers

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

General Provider Information

NPI Number : 1184691222
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY LOUISE RUSSELL MD
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER DR
Second Line : P.O.BOX 9196
City : MORGANTOWN
State : WV
Zip : 26506-1200
Country : US
Telephone Number : 304-293-3909
Fax Number : 304-293-7042
Provider Business Practice Location Address
First Line : 1405 SHADY AVE
Second Line :
City : PITTSBURGH
State : PA
Zip : 15217-1350
Country : US
Telephone Number : 412-420-2270
Fax Number : 412-420-4450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 04/12/2022

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