Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | MD048688L | PA |
NPI | 1336164946 |
---|---|
Provider Name | Dr. Tod S Russell |
First Address | Goldsboro, NC 27531-2310 |
Second Address | Goldsboro, NC 27531-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |