Active NPI
Stephanie F Russo, MD
- Pediatrics Physician
- Erie, PA
National Provider Identifier
1811968498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD043940L
- Practice address
- 3910 Caughey Rd
Suite 170
Erie, PA 16506-4096 - Phone
- (814) 838-3480
- NPI assigned
- Jan 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD043940L | PA | Primary |
Addresses
Primary practice location
3910 Caughey Rd
Suite 170
Erie, PA 16506-4096
Mailing address
3910 Caughey Rd
Suite 170
Erie, PA 16506-4096
Phone (814) 838-3480
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD043940L | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306195200000",
"number": "1811968498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3910 CAUGHEY RD",
"address_2": "SUITE 170",
"city": "ERIE",
"state": "PA",
"postal_code": "165064096",
"telephone_number": "814-838-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3910 CAUGHEY RD",
"address_2": "SUITE 170",
"city": "ERIE",
"state": "PA",
"postal_code": "165064096",
"telephone_number": "814-838-3480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "STEPHANIE",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-31",
"last_updated": "2011-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD043940L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.