Lawrence Benidict Russell, PA-C

Key facts

NPI

1336148147

Entity type

Individual (NPI type 1)

Primary specialty

Physician Assistant 363A00000X

License

MA000191L (PA)

Practice address

7287 W Ridge Rd
Fairview, PA 16415-1130

Phone

(814) 877-2360

Fax

(814) 474-3561

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 16, 2013.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366070400000",
    "number": "1336148147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7287 W RIDGE RD",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164151130",
            "telephone_number": "814-877-2360",
            "fax_number": "814-474-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7287 W RIDGE RD",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164151130",
            "telephone_number": "814-877-2360",
            "fax_number": "814-474-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "LAWRENCE",
        "middle_name": "BENIDICT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2013-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA000191L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00111403",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview, PA

• Regional Health Services Inc
• Regional Health Services Inc
• Regional Health Services, Inc.
• Nathan Edward Rieck, DMD
• Destiny Marie Riordan, CRNP
• Sandusky Surgeons, Inc
• Jordan Sanfrotello, DPT
• Pino Joseph Scavella, OTR/L
• Walter R. Schamber, PHD
• Schauer Physical Therapy Inc

All providers in Fairview, PA · Physician Assistant in Pennsylvania