MEDICARE: DR. EPHAT HADAS RUSSCOL 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
1	208000000X	Pediatrics Physician	246598	MA
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	246598	MA

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

General Provider Information

NPI Number	:	1598925356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EPHAT HADAS RUSSCOL MD

Provider Business Mailing Address
First Line	:	109 OAK ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1492
Country	:	US
Telephone Number	:	781-619-1500
Fax Number	:	781-619-1509

Provider Business Practice Location Address
First Line	:	109 OAK ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1492
Country	:	US
Telephone Number	:	781-619-1500
Fax Number	:	781-619-1509

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

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	06/10/2025

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