MEDICARE: ASHLEY ROSEMAE RUSSELL 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	35.146812	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35.146812	OTHER	OH	OH MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891377685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROSEMAE RUSSELL MD

Provider Business Mailing Address
First Line	:	419 E. PERKINS AVENUE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870
Country	:	US
Telephone Number	:	419-557-7455
Fax Number	:	419-557-7782

Provider Business Practice Location Address
First Line	:	419 E. PERKINS AVENUE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870
Country	:	US
Telephone Number	:	419-557-7455
Fax Number	:	419-557-7782

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

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	06/09/2026

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