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NPI Code Detail

MEDICARE: DR. JAMES RUSSELL SAMPLE JR. D.O.

MEDICARE: DR. JAMES RUSSELL SAMPLE JR. D.O.
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
1207P00000XEmergency Medicine PhysicianOS013679PA
2207P00000XEmergency Medicine Physician34.008207OH

General Provider Information

NPI Number : 1255307435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES RUSSELL SAMPLE JR. D.O.
Provider Business Mailing Address
First Line : 800 FAIRVIEW RD
Second Line :
City : PITTSBURGH
State : PA
Zip : 15238-1706
Country : US
Telephone Number : 412-656-4557
Fax Number :
Provider Business Practice Location Address
First Line : 532 W PITTSBURGH ST
Second Line :
City : GREENSBURG
State : PA
Zip : 15601-2239
Country : US
Telephone Number : 724-832-4358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 08/06/2022

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