MEDICARE: RUSSELL AMUNDSON 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	207T00000X	Neurological Surgery Physician	MD428933	PA

General Provider Information

NPI Number	:	1609816354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL AMUNDSON MD

Provider Business Mailing Address
First Line	:	101 E OLNEY AVE
Second Line	:	SUITE 505
City	:	PHILA
State	:	PA
Zip	:	19120-2421
Country	:	US
Telephone Number	:	215-456-7000
Fax Number	:	215-254-2599

Provider Business Practice Location Address
First Line	:	5401 OLD YORK RD
Second Line	:	SUITE 501
City	:	PHILA
State	:	PA
Zip	:	19141-3030
Country	:	US
Telephone Number	:	215-456-6127
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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