Active NPI
Mark William Russell, P.T.A.
- Community Health Worker
- Edenton, NC
National Provider Identifier
1437314366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 3666
- Practice address
- 108 Schooner Landing Dr
Edenton, NC 27932-8833 - Phone
- (252) 632-4137
- NPI assigned
- Jul 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 3666 | NC | Primary |
Addresses
Primary practice location
108 Schooner Landing Dr
Edenton, NC 27932-8833
Mailing address
108 Schooner Landing Dr
Edenton, NC 27932-8833
Phone (252) 632-4137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3666 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216598400000",
"number": "1437314366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 SCHOONER LANDING DR",
"city": "EDENTON",
"state": "NC",
"postal_code": "279328833",
"telephone_number": "252-632-4137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 SCHOONER LANDING DR",
"city": "EDENTON",
"state": "NC",
"postal_code": "279328833",
"telephone_number": "252-632-4137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MARK",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "P.T.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-21",
"last_updated": "2008-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NC",
"license": "3666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edenton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.