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NPI Code Detail

MEDICARE: LAWRENCE BENIDICT RUSSELL PA-C

MEDICARE: LAWRENCE BENIDICT RUSSELL PA-C
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
1363A00000XPhysician AssistantMA000191LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00111403OTHERPARR MEDICARE

General Provider Information

NPI Number : 1336148147
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE BENIDICT RUSSELL PA-C
Provider Business Mailing Address
First Line : 7287 W RIDGE RD
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415-1130
Country : US
Telephone Number : 814-877-2360
Fax Number : 814-474-3561
Provider Business Practice Location Address
First Line : 7287 W RIDGE RD
Second Line :
City : FAIRVIEW
State : PA
Zip : 16415-1130
Country : US
Telephone Number : 814-877-2360
Fax Number : 814-474-3561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 04/16/2013

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Directions to “ LAWRENCE BENIDICT RUSSELL PA-C” Practice Location

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