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NPI Code Detail

MEDICARE: JACQUELINE M RUSSELL DO

MEDICARE: JACQUELINE M RUSSELL DO
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
1207Q00000XFamily Medicine PhysicianDO3305ME

General Provider Information

NPI Number : 1730742107
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE M RUSSELL DO
Provider Business Mailing Address
First Line : 210 HOLMES RD
Second Line :
City : SCARBOROUGH
State : ME
Zip : 04074-8410
Country : US
Telephone Number : 207-995-0732
Fax Number :
Provider Business Practice Location Address
First Line : 37 PALMER ST STE 3
Second Line :
City : CALAIS
State : ME
Zip : 04619-1341
Country : US
Telephone Number : 207-454-8195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2019
Last Update Date : 09/08/2023

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Directions to “ JACQUELINE M RUSSELL DO” Practice Location

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