Glenn Gerard Russo, M.D.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

017336 Issued in LA

Practice address

120 Meadowcrest St
Suite 160
Gretna, LA 70056-5255

Phone

(504) 391-7620

Fax

(504) 391-7624

NPI assigned

Mar 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265155200000",
    "number": "1083683445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OLIVE AVE",
            "city": "HARVEY",
            "state": "LA",
            "postal_code": "700584456",
            "telephone_number": "504-366-5035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST",
            "address_2": "SUITE 160",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700565255",
            "telephone_number": "504-391-7620",
            "fax_number": "504-391-7624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "GLENN",
        "middle_name": "GERARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2010-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "LA",
            "license": "017336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwin B. Ross Jr., MD
• Stephanie Roubion
• Chad M Rudolph, PHARM D.
• Natha Lee Ruffin
• Russell Schafer Dental Clinic LLC
• Gordon J Russo, MD
• Peter Russo
• S & C Total Living Inc.
• S & C Total Living Inc.
• S & C Total Living Inc.

• Procedural Dermatology Physician in Gretna, LA
• Providers in Gretna, LA by specialty
• Procedural Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.