MEDICARE: DR. RUSSELL J MUNSON 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	023004	CT

General Provider Information

NPI Number	:	1619956760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL J MUNSON M.D.

Provider Business Mailing Address
First Line	:	15 SPRING ST
Second Line	:
City	:	CHESTER
State	:	CT
Zip	:	06412-1338
Country	:	US
Telephone Number	:	860-526-2548
Fax Number	:	860-526-4043

Provider Business Practice Location Address
First Line	:	15 SPRING ST
Second Line	:
City	:	CHESTER
State	:	CT
Zip	:	06412-1338
Country	:	US
Telephone Number	:	860-526-2548
Fax Number	:	860-526-4043

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	07/08/2007

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