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NPI Code Detail

MEDICARE: MR. RUSSELL M ELDRIDGE MD

MEDICARE: MR. RUSSELL M ELDRIDGE 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
1207RH0003XHematology & Oncology Physician29507KY

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 : 1548261423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RUSSELL M ELDRIDGE MD
Provider Business Mailing Address
First Line : 230 LEXINGTON GREEN CIR
Second Line : STE 600
City : LEXINGTON
State : KY
Zip : 40503-3326
Country : US
Telephone Number : 859-971-4695
Fax Number : 859-971-4604
Provider Business Practice Location Address
First Line : 1720 NICHOLASVILLE RD
Second Line : #701
City : LEXINGTON
State : KY
Zip : 40503-1475
Country : US
Telephone Number : 859-276-0414
Fax Number : 859-276-3765
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 11/15/2017

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