MEDICARE: NOREEN RUSSO PA

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1952508046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOREEN RUSSO PA

Provider Business Mailing Address
First Line	:	205 PAGE RD
Second Line	:
City	:	PINEHURST
State	:	NC
Zip	:	28374-8749
Country	:	US
Telephone Number	:	910-295-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 MURDOCKSVILLE RD
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-8871
Country	:	US
Telephone Number	:	910-255-0055
Fax Number	:	910-255-0060

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

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	03/17/2018

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Directions to “ NOREEN RUSSO PA” Practice Location

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