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1427030378

NPI Code Detail

MEDICARE: RUSSELL W COURNOYER JR. DPM

MEDICARE: RUSSELL W COURNOYER JR. DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1767	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	480026268	OTHER		RAILROAD MEDICARE
7	Y70847	OTHER		MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042472266	OTHER		PRIVATE HEALTHCARE SYSTEM
2	042472266	OTHER		TRICARE/CHAMPUS
3	965657	OTHER		FIRST HEALTH
5	AA2838	OTHER		HARVARD PILGRIM HEALTHCAR
6	042472266	OTHER		THREE RIVERS
8	Y70910	OTHER		BLUE SHIELD HMO BLUE
9	4886875	OTHER		CIGNA PAL ID
10	9900050	OTHER		FALLON COMMUNITY HLTH PL
11	26734	OTHER		CHILDRENS MED SECURITY PL
12	7042342	OTHER		AETNA/US HEALTHCARE
13	785949	OTHER		MVP HEALTH CARE
14	042472266	OTHER		ONE HEALTH PLAN
15	26734	OTHER		HEALTHY START
16	Y70910	OTHER		BLUE CARE ELECT
17	Y70910	OTHER		BLUE SHIELD INDEMNITY
18	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427030378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL W COURNOYER JR. DPM

Provider Business Mailing Address
First Line	:	5 NEPONSET ST FL STREET12
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-2714
Country	:	US
Telephone Number	:	508-856-9181
Fax Number	:	508-425-6177

Provider Business Practice Location Address
First Line	:	5 NEPONSET ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01606-2714
Country	:	US
Telephone Number	:	508-856-9181
Fax Number	:	508-425-6177

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	09/26/2018

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Directions to “ RUSSELL W COURNOYER JR. DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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