MEDICARE: DR. PETER CRIAG RUSS M.D

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	207Q00000X	Family Medicine Physician	028399	CT
2	207Q00000X	Family Medicine Physician	2007-00384	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00716054	OTHER		MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1568460921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER CRIAG RUSS M.D

Provider Business Mailing Address
First Line	:	1269 US HWY 221A
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-5921
Country	:	US
Telephone Number	:	828-657-5371
Fax Number	:	828-657-9190

Provider Business Practice Location Address
First Line	:	1269 US HWY 221A
Second Line	:
City	:	FOREST CITY
State	:	NC
Zip	:	28043-5921
Country	:	US
Telephone Number	:	828-657-5371
Fax Number	:	828-657-9190

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	12/07/2023

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Directions to “ DR. PETER CRIAG RUSS M.D” Practice Location

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